2002 Kishwaukee Youth Football League Registration Form & Liability Waiver

 

Registering for:††††††††††††††††††††††† Football ††††††††††††††††††††† Cheerleading______

 

 

Participantís Name _______________________††††† Date of Birth ____________________

Address ________________________________††††† Childís Height ___________________

City ___________________________________††††† Childís 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 †††††††††††††† _____________

 

 

Fatherís Name _______________________†††††††††††† Motherís 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_____

 

 

Liability Waiver

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 childís 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