OFFICIAL REGISTRATION FORM

 

DATE:                            

 

PLAYER’S NAME:                                                                                      

 

ADDRESS:                                                                                                               

 

CITY/STATE:                                                               PHONE:                             

 

GRADE:             AGE:               SCHOOL DISTRICT:                                         

 

PLAYER STATUS:               NEW                           RETURNING

 

            I/WE, THE PARENTS OR LEGAL GUARDIAN OF THE ABOVE NAMED PLAYER WHO IS A CANDIDATE FOR A POSITION ON A CENTRAL PENNSYLVANIA YOUTH FOOTBALL LEAGUE (CPYFL) TEAM, HEREBY GIVE MY/OUR APPROVAL FOR HIS/HER PARTICIPATION IN ANY AND ALL ACTIVITIES OF THE CPYFL PROGRAM DURING THE CURRENT SEASON.  I/WE ASSUME ALL RISKS AND HAZARDS INCIDENTAL TO THE CONDUCT OF THE ACTIVITIES AND TRANSPORTATION TO AND FROM LEAGUE FUNCTIONS.  I/WE FURTHER HEREBY RELEASE, ABSOLVE, INDEMNIFY, AND HOLD HARMLESS THE CPYFL, THE SPONSORS, THE COACHES AND THE SUPERVISORS FOR ANY LIABILITY RISING OUT OF THE ABOVE NAMED PLAYER PARTICIPATION IN SAID PROGRAM.  IN CASE OF INJURY TO MY/OUR CHILD, I/WE HEREBY WAIVE ALL CLAIMS AGAINST THE CPYFL, THE COACHES OR SUPERVISORS APPOINTED BY IT.  I/WE LIKEWISE RELEASE FROM LIABILITY ANY PERSON TRANSPORTING MY/OUR CHILD TO OR FROM THESE ACTIVITIES.  THE CPYFL RESERVES THE RIGHT TO CHECK AND QUESTION ALL INFORMATION STATED ON THIS REGISTRATION APPLICATION WITHOUT ANY RECOURSE TO THIS LEAGUE OR INDIVIDUALS ASSIGNED BY THIS LEAGUE.

 

PARENT/GUARDIAN SIGNATURE:                                                                   

 

DATE OF BIRTH:                                       

 

DOCTOR’S EXAMINATION REPORT

 

THE ABOVE CHILD HAS BEEN EXAMINED BY ME AND IS FIT TO PLAY FOOTBALL.

 

DOCTOR’S SIGNATURE:                                                                                  DATE:                                 

 

 

 

 

 

 

PLAYER REGISTRATION FORM

 

Player Information

Name:                                                                                                                                     Phone:                                   

Address:                                                                                                                                                Grade:                                    

                                                                                                                               

School:                                                                                                                  

Date of Birth:                        /               /                                                                               Age (as of July 1):               

 

Parent/Guardian Information

Name:                                                                                                                                     Phone (H):                            

Address:                                                                                                                               

                                                                                                                               

Employer:                                                                                                                              Phone (W):                           

 

Person to Contact Other than Parent/Guardian in case of an Emergency

Name:                                                                                                                                     Phone (H):                            

Address:                                                                                                                                                Relationship:                        

                                                                                                                               

Employer:                                                                                                                              Phone (W):                           

 

Emergency Information

Doctor:                                                                                                                                   Phone:                                   

Insurance:                                                                                                                             Policy #:                                

                                                                                                                                                Group #:                                

 

Medical Information

Heart Condition or Disease                yes          no                           Asthma                                  yes          no

Allergic to insect sting                        yes          no                           Allergic to Medications      yes          no

Diabetes                                                                yes          no                           Convulsion Disorder           yes          no

Date of Last Tetanus Shot                                                                

List Allergies:                                                                                                                                                                      

                                                                                                                                                                                               

List Current Medications                                                                                                                                                   

                                                                                                                                                                                               

Other Health Problems                                                                                                                                                       

                                                                                                                                                                                               

 

In the event of an emergency occurring while my son/daughter is on a Youth Football sponsored activity, practice, game, or trip, I grant permission to the supervisors, coaches or other person in charge to take whatever action necessary in the event that I cannot be reached.  I hereby authorize the previously mentioned person to give consent for my son/daughter to receive medical treatment.

 

If you DO NOT grant permission or authorization for consent to medical treatment, what procedure should be followed?

                                                                                                                                                                                                                                                                                                                                                                                               

 

I also understand that I will be financially responsible for the loss or destruction of issued equipment.

 

                                                                                                                                                                               

Parent/Guardian Signature                                                                                 Date