2002 Kishwaukee Youth Football League Registration Form & Liability Waiver
Registering for: Football Cheerleading______
Participant’s Name _______________________ Date of Birth ____________________
Address ________________________________ Child’s Height ___________________
City ___________________________________ Child’s Weight ___________________
Phone _________________________________ School (fall of 2002)______________
Grade (fall of 2002)_______________________ Years of experience in organized
Male Female football or cheerleading/dance/
E-mail (optional)__________________________ gymnastics _____________
Father’s Name _______________________ Mother’s Name _____________________
Address ____________________________ Address ___________________________
City _______________________________ City ______________________________
Home Phone ________________________ Home Phone _______________________
Work Phone ________________________ Work Phone ________________________
Mobile Phone _______________________ Mobile Phone _______________________
Emergency Guardian (if not above)
Contact __________________________ ______________________________
Relationship ________________________ Address _______________________
Address ____________________________ City ___________________________
City _______________________________ Home Phone ___________________
Phone _____________________________ Work Phone ___________________
Mobile Phone __________________
Doctor _____________________________ Dentist ________________________
City _______________________________ City ___________________________
Phone _____________________________ Phone _________________________
List any known health problems that the coach should be made aware of: ________________________________________________________________________________________________________________________________________________________________________________
To be completed by KYFL
Helmet XS_____ Small_____ Med._____ Large_____ XL_____ Jumbo_____
Shoulder Pads XS_____ Small_____ Med._____ Large_____ XL_____ Jumbo_____
Pants XS_____ Small_____ Med._____ Large_____ XL_____ Jumbo_____
I/We the parents/legal guardian of the above named child/participant hereby give our permission for him/her to participate in the Kishwaukee Youth Football League Football/Cheerleading program and any and all league activities. I/We hereby waive, release, absolve, indemnify and agree to hold harmless the organizers; sponsors; supervisors; participants; coaches; officials; board members; league officials; and persons transporting my/our child to and from activities; for any claim arising out of an injury to my/our child, whether the result of negligence or for any other cause, except to the extent and in the amount covered by accident or liability insurance. This waiver is being made knowingly, and is being made on behalf of the undersigned, the child, and child’s parents/legal guardians. This waiver is final and irrevocable.
Date: ________________ _____________________________________________
Parent/Legal Guardian
Emergency Medical Care Authorization
In case of emergency and parents/legal guardian and/or family physician cannot be contacted, I authorize league officials/coaches to transport my child to a hospital/medical facility and give permission for said hospital/medical facility to give my child emergency care treatment.
Date: ________________ _____________________________________________
Parent/Legal Guardian