YMCA Flag Football League

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Player Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Team (If none please type none):

Street:

* City:

State:

Zip Code:

* Phone:

Birthdate:

* Email:

* Age:

Desired Positions:

Previous Football experience:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

In consideration for being permitted by the Medina Flag Football League to participate in the above activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the Medina Flag Football League (its officers, employees and agents) from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above persons or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity.

I am aware that there are rules and regulations governing the flag football program. I know, or have read these rules and understand them. My signature on this agreement, waiver, and release indicates I agree to abide by the rules. I am aware that failure to abide by these rules may result in disciplinary action which could result in my suspension from this program for several games or for life, depending on the severity of my actions.

Note: If you are under 18 years of age, you must have a parental consent form in addition to your signature below to participate.

I/we agree with the above *

* indicates required fields

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