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BOBCATS Football / Cheerleading       Football / Cheerleading       Football / Cheerleading Cash / Check #

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Name:

Age:

Sex:

D.O.B.

Address:

City:

State:

Zip:

FOOTBALL  PLAYERS  ONLY

Height

Weight

Grade:

School:

School District:

Parent /Guardian Names

Home Phone

Cell Phone

Work Phone

Family Physician:

Phone:

Choice of Specialist (if needed):

Allergies:

Medications:

Health Problems Team should be aware of:

Date of Last Tetanus:

Insurance:

Policy Number:

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AUTHORIZATION:  I hereby authorize my child to participate in the JVFL and this Organization football and cheerleading program.

RELEASE:  In consideration  of the JVFL and this Organization allowing my child to participate in youth athletics, I hereby agree to release, waive, discharge, covenant, not to sue, hold harmless, and indemnify, on behalf of myself and my other parent/guardian of my child, the JVFL and this Organization, their respective coaches, volunteers, officials, agents, sponsors, directors, members, and other staff members from liability to us and out child as well as out personal representatives, assigns heirs and next of kid for any and all legal claims, suits or causes of action arising from or out of any injury, known or unknown, to property or body, that your child may suffer from participation in the JVFL or this Organization’s program and/or sports activities.

CERTIFICATION:  I, the undersigned, hereby certify that to the best of my knowledge, my child is physically fit and able to safely participate in the sports activity for which he/she has registered.

EMERGENCY MEDICAL CARE:  In addition, I understand that in the case of illness or injury, the organization will attempt to notify me or another listed emergency contact.  In the event of a medical emergency concerning my child when my contact persons or I can not be located, I hereby authorize the Organization to obtain the necessary medical care and treatment for my child.  This care is including, but not limited to first aid, X-rays, examinations, diagnosis and treatment, transportation, or hospital care.

MEDICAL FINANCIAL RESPONSIBILITY: I understand that I, either personally or through my medical insurance provider, am financially responsible for any and all medical care, treatment, emergency care, and emergency transportation of any child in the event any of these services are needed.

EXPECTATION:  I understand that I am responsible for the safe transportation of my child to and from practices, scrimmages, and games both home and away.

RELEASE:  Photographs will occasionally be taken of the children during the sports activities.  By signing this registration form, I consent that the JVFL or the Organization may use the pictures of my child for display, brochures, promotional materials, website, or any other media outlet to promote their program without compensation to my child or me.

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Parent/Guardian Signature                                                                                                                      Date