Lower Dauphin Falcons Youth Football

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LDYFA Football Registration Form 2017

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home Phone:

* Birthdate:

* Gender:

* Age as of April 30:

* Email:

* Grade:

* Current Weight:

* Returning Player:

* What School District Does the Player Live In?:

* What School Does The Player Attend?:

* Tee Shirt Size:

If player is 13 years old on 4/30 player is eligible - If player is 14 on 4/30 player is ineligible

* Registering as:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Employer:

* Home Phone:

* Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Employer:

Email:

Home Phone:

Work Phone:

Cell Phone:

I can help by:

I would be willing to help with the following:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

* Family Doctor- name and phone number:

* Family Dentist- name and phone number:

Allergies, Medications Taken Regularly, Medical or Physical Conditions, Hospital Preference:

WAIVER INFORMATION

Lower Dauphin Youth Football Association Inc.
Rules for Participants & Parent’s Responsibility / Permission
1. Participants must attend all practices and games unless excused by their Head Coach. Any child not physically participating in 50% of the scheduled practices will be ineligible a minimum of the first quarter of the said week’s game and will be at the discretion of the Head Coach.
2. Any misconduct, swearing, fighting, disobedience to coaches, team players, trainers, board members, etc. will not be tolerated and disciplinary action will be taken.
3. Participants are responsible for all equipment and uniforms issued to them. Any equipment issued and not returned will be paid for by the participant’s Parent/Guardian. Uniforms should be clean for all games. DO NOT USE ANY BLEACH!
4. Parents are responsible for the return of any money, tickets or merchandise given to the participants in connection with any money-making projects. To ensure accurate records, all money must be returned to the LDYFA Booster Club by said day only. Checks (payable to Lower Dauphin Youth Football Association Inc.) or money orders are preferred.
5. On game day, all teams and team members will stay only in an area designated by their coach prior to the game.
6. On game day, our players will stay on our side of the field unless the location of the concession stand or restrooms necessitate otherwise. There will be no playing ball, running or creating other misconduct. Parents are responsible for their children’s actions prior to games and practices. Parents are expected to control their children at the games, except when under the control of their coaches.
7. All parents having any questions, suggestions, constructive criticism or complaints are asked to contact the coach, the General Manager or a member of the Board of Directors. Any action to be taken or questions to be answered will be taken care of as soon as possible. Parents are prohibited from the practice and playing field.

POLICY AND CONSENT AFFIDAVIT
The undersigned parent or legal guardian of the above mentioned player/cheerleader does hereby grant permission for him/her to participate in any and all activities of the Lower Dauphin Youth Football Association Inc. I assume all risks and hazards incidental to such participation including transportation to and from activities. I agree to be legally and financially responsible and hereby waive, release, absolve, indemnify and hold harmless the Lower Dauphin Youth Football Association Inc. (“LDYFA”), Organizers, Coaches, Sponsors, Participants, and persons transporting my child to and from activities for all claims, demands, acts or causes of action for damage or any other circumstances, on account of or in any way graowing out of any and all known and unknown personal injuries and property damage.
I also hereby authorize the Lower Dauphin School District to release a copy of the above-named participant’s report card for the first quarter of the school year and/or an official list with my child’s name, grade, and honor roll status to the CFA and to the LDYFA for the sole purpose of honoring the student’s academic achievements. The release of this information is solely for the purpose of the CFA Scholastic Program.
I HAVE READ AND FULLY UNDERSTAND THE LDYFA RULES FOR PARTICIPANTS AND PARENTS’ RESPONSIBILITY

I/we agree with the above *

* indicates required fields

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LDYFA Football Registration Form 2017