Southwest Cardinals Football and Cheerleading Registration Form
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! Indicates required information
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Player Information
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| ! Last Name: |
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| ! First Name: |
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| ! DOB: |
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| ! Gender: |
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| ! Address: |
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| ! Home Phone: |
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| ! City: |
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| ! Zip: |
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| Grade: |
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| School: |
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| ! Age on August 1 of this year: |
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| Sport: |
Football
Cheerleading
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| Years played?: |
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| Weight (Football only): |
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Parent/Guardian Emergency Contact Information (please be complete as possible)
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| ! Parent 1: First & Last Name: |
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| P1 Relationship: |
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| P1 Work Phone: |
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| P1 Cell Phone: |
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| ! P1 E-mail: |
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| Parent 2: First & Last Name: |
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| P2 Relationship: |
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| P2 Work Phone: |
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| P2 Cell Phone: |
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| P2 E-mail: |
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Medical Information
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| Family Physician: |
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| FP Phone: |
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| Insurance Carrier: |
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| Policy Number: |
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Medical History (Allergies, Medications, Special Conditions, etc.)
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IMPORTANT NOTE: If the player is under medical care or is on prescribed medication, a note from his/her physician is required.
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Parent Permission
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Requirements: I must be present at all practices and games and am not allowed to drop my child off. Equipment will be issued when full registration payment is received. Players will not be allowed to participate in the Southwest Youth Football Association games if payment is not paid in full. Fees include rental of game uniform, football or cheerleading equipment which are the property of SWYFA and must be returned by the end of the season.
Equipment deposit $200 forfeit: I agree to pay the cost of any lost or non-returned equipment issued to my child or me by SWYFA. I understand my deposit will be returned uncashed upon the return of equipment.
Concession Duty deposit $75 forfeit: I agree to work a minimum of two (2) hours during the season at either the concession stand or the gate as assigned by the SWYFA Concession Director and it is my responsibility to work this shift. I further understand that I may opt-out at registration with payment of $75, or if I do not work the assigned shift my deposit check will be cashed.
Medication Authorization – Grant of Consent. I hereby certify that my child is in good health and may participate in all activities. In case of an emergency, I give my permission for my child to be given emergency treatment at any responsible accessible hospital.
Liability Waiver: AS the parent (or legal guardian) of the above named minor, I grant permission for the minor to participate in all activities of the sports program. I assume all risk and hazards incidental to such participation, including transportation to and from such activities, and do hereby release and waive all claims against Southwest Youth Football Association Incorporated, North Georgia Youth Football League, American Youth Football, Sponsors, volunteers, agents and other participants. I understand I am responsible for all medical and accident insurance.
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| ! Participation Permission: |
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Signature: _________________________________________________
Date: ___________________________________________________
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The following fields are for the Southwest Youth Football Association, Inc. use only.
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Membership Number
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| Member No.: |
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PAYMENT INFORMATION:
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| Registration Fee: |
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| RF Payment Form: |
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| RF Control No.: |
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| RF Receipt No.: |
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| Equipment Deposit: |
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| ED Payment Form: |
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| ED Control No.: |
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| ED Receipt No.: |
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| Concession Deposit: |
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| CD Payment Form: |
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| CD Control No.: |
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| CD Receipt No.: |
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EQUIPMENT ISSUE:
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| Issue Date: |
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| Helmet: |
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| Shoulder pads: |
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| Game pants: |
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| Pad Set: |
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| Shell: |
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| Skirt: |
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| Pom-poms: |
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! Indicates required information
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