Cuba Youth Football

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Cuba Youth Football Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Birthdate:

* Telephone:

Email:

* Gender:

* What Grade will you enter in the fall of 2016? Select One:

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

e-mail:

* Telephone:

Telephone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Telephone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Telephone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

Cuba Youth Football League

In consideration of the use of the property, facilities and/or services of Cuba Youth Football League (the “league”) or any auxiliary organizations participating or sponsoring recreational sports programs, including travel related thereto, and the minor child ________________________________s participation in said programs, the undersigned agrees as follows:

1. RISK FACTORS: The undersigned understands and acknowledges that the use of equipment, facilities, and services provided by the League and participation in the League involves risks such as, but not limited to, the following which might result from the use of equipment or facilities, from the activity itself, from the acts of others, or from the unavailability of emergency or emergency medical care: RISK OF PROPERTY DAMAGE, BODILY INJURY AND POSSIBLE DEATH.

2. ASSUMPTION OF RISK, the undersigned ASSUMES ALL RISKS THAT ARISE OUT OF THE USE OF THE EQUIPMENT OR FACILITIES, THE ACTIVITIES ITSELF, THE ACTS OF OTHERS, OR THE UNAVAILABILITY OF EMERGENCY CARE, including but not limited to, those RISK FACTORS described in section 1 above.

Item 1-2: ____________(Initials)

3. RELEASE. The undersigned RELEASE the League, auxiliary organizations, the officers, employees, volunteers, and agents of each and agrees NOT TO SUE them on account of or in conjunction with any claims, causes of action, injuries, damage, cost of expenses arising out of the activity, including those based on death, bodily injury or property damage whether or not caused by the acts, omission or other fault of the parties being released.

4. WAIVER. The undersigned waives the protection afforded by any statue or law whose material or otherwise which the person giving the release does not know of or suspect at the time of executing the release. This means, in part, that the undersigned is releasing unknown future claims.

5. INDEMNIFY AND DEFEND. The undersigned agrees to IDEMNIFY AND DEFEND the League, auxiliary organizations, the officers, employees, volunteers, and agents (hereinafter referred to as “indemnitee”) of each against, and hold them harmless from any or all claims, causes of action, damage judgments, costs or expenses, including attorney fees which in any way arise from the activity of this agreement which include but are not limited to, damages to or destruction of any property of the indemnitee, of any others, injury or death of the undersigned or anyone else or any liability arising from the act or negligent act of the indemnitee, the undersigned or anyone else.

Item 3-5: ______________(Initials)

6. PAY. The undersigned agrees to pay for any or all damages to any property or indemnitee caused by the undersigned either negligently, willfully, or otherwise.

7. REPRESENTATIVES. The undersigned enters into this agreement for himself/herself, his/her heirs, assigns and legal representatives.

Item 6-7: _______________(Initials)

8. MEDICATIONS AND TREATMENT. The undersigned understands that the League and its auxiliaries are not permitted to administer medications or treatments to participants. In the event of a medical emergency, the League will contact emergency medical personnel for treatment and possibly transportation to a medical facility. Any expense for treatment or transportation will be the responsibility of the participant.

9. EMERGENCY TREATMENT CONSENT. The undersigned, as a participant in the subject activity, hereby consent to medical treatment of the minor child ____________________________ in a medical emergency where the undersigned is unable to consent to such treatment.

10. PHYSICAL EXAM. The undersigned understands that each participant is required to obtain a Physical Examination administered by a qualified Health Professional and provide the completed form to the League.

11. INSURANCE. The undersigned understands that the League and its auxiliaries do not carry participant insurance. The undersigned is encouraged to have the minor child _________________________ purchase health insurance prior to any and all participation.

Item 8-11: _______________(Initials)

12. IDENTIFICATION. The undersigned understands that each participant is required to provide a State issued Identification Card to be kept on file by the League for the duration of the season.

13. PHOTOGRAPHY. The undersigned understands that each participant may be photographed in the course of the season and that these photographs may be used by the League for promotional purposes including but not limited to newspapers, Internet, and other promotional literature.

Item 12-13: ________________(Initials)

14. EQUIPMENT. The undersigned understands that each participant will be provided with a football helmet, shoulder pads, football pants, and game jersey by the League. These items are property of the League and must be returned at the designated time and place. For safety concerns, should a participant wish to provide their own helmet, shoulder pads, or football pants, they must be approved by the League. Participants are required to provide appropriate footwear, mouth guard, and a protective cup at the participant’s expense.

15. PARTICIPATION. Each participant is expected to attend ALL practice and game activities at the time and locations designated by the league. Many games are played in other communities and the participant will provide their own transportation.

Item 14-15: ________________(Initials)

16. ACKNOWLEDGMENT. The undersigned has read and understands his agreement and realizes it relates to surrendering valuable legal rights and does so freely and voluntarily.

Item 16: ________________(Initials)

Signature:________________________________________

Date:____________________

CONSENT AND RELEASE ON BEHALF OF MINOR

Player’s Name:_________________________________ Grade:_____________________________

I am the parent and/or legal guardian of the above name minor. I have read and understand the agreement involves surrendering valuable legal rights of the minor and myself. I agree to be bound by all terms of this agreement. I also give my consent to the participation in the activity of the minor.

Registration Form form MUST be INITIALED & SIGNED in the presence of a League Official by Parent or Guardian and League Official!

______________________________________
Print name of Parent/Legal Guardian

______________________________________
Signature of Parent/Legal Guardian

______________________________________
Print name of League Official

______________________________________
Signature of League Official

______________________
Date:

In cases of joint custody both parents must sign a release
Consent and Release on Behalf of Minor

I understand and will abide by all items listed above *

Please print this form. Registration Form form MUST be INITIALED & SIGNED in the presence of a League Official by Parent or Guardian! *

Participants registering online will need to print, read, and sign the Player and Parent Contract which is located in the Forms section of the Menu! Please bring the completed form with you when submitting your Registration Form! *

The Player Registration Fee for the 2016 season is $90. Each additional Player from the SAME Family is $80.

THANK YOU for registering! If you would like to PAY ONLINE, please click the ONLINE Payment button at the bottom of the Welcome Page and you will be redirected to PayPal. Session cookies need to be enabled on your browser! PayPal, Credit or Debit Card are accepted ONLINE or pay by Credit or Debit Card, Check, or Money Order when you present your Registration Form on Open Enrollment Days. It is the responsibility of the parent/legal guardian of the participant to ensure that payment is made prior to participation of any league activity. Should a player be dismissed from the league or voluntarily leave the league, NO REFUND's of Registration Fee's will be made.

You may also mail your check or money order made out to Cuba Youth Football to:

Cuba Youth Football
C/O Luke Miller
2161 White Fawn
Cuba, MO 65453

* indicates required fields

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

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Cuba Youth Football Registration