GRID IRON TEXANS YOUTH FOOTBALL

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Select Tackle Football-Player Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

* Home Phone:

Birthdate:

Email:

Gender:

Grade:

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 #:

PARENT/PLAYER WAIVER INFORMATION

Parent/Guardian Authorization, Release, and Indemnifying Agreement

I/We, the parents/guardians of the above named player, do hereby assume all liability and give approval for his/her participation in any and all activities concerning the assigned team for the current season. I/We assume all risks and hazards incidental to such participation including transportation to and from the activities and so hereby waive, release, absolve, and indemnify and agree to hold harmless all sponsors, supervisors, or participants in any and all activities of the team GRID IRON Texans for any claim arising out of injury to the player for any other reason. I/We also grant permission to the supervisors, physicians, hospitals, or medical clinic should be the boy/girl become ill or injured while participating in activities away from or at any other time when neither parent nor guardian is available, to grant authorization for emergency treatment. I/we also give permission for that representative to obtain ambulance service if it is deemed necessary.

I/we agree with the above *

Signature:

Date:

Signature:

Date:

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IMPORTANT: Online Payment with credit cards is not active for this form

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Select Tackle Football-Player Registration Form