Farmingdale Hawks Midget Football and Cheerleading - (Farmingdale, NY)

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Hawks On-line Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

* School:

Zip Code:

Home Phone:

Birthdate:

Gender:

Grade:

PARENT/GUARDIAN

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

Release of Liability

In consideration of being allowed to participate in any way in the FARMINGDALE HAWKS program, its related

events and activities, I, ______________________, the undersigned, acknowledge, appreciate,and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and,

4. I, for myself and behalf of my heirs, assigns, personal representatives and next of kin, HEARBY RELEASE, INDEMNFY, AND HOLD HARMLESS THE FARMINGDALE HAWKS, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

X ___________________________________ Age: _________ Date Signed:___________

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

Consent Of Parent or Guardian

I, the undersigned, being the parent or guardian of

(Name):

do hereby grant permission for his/her participation in all activities,

athletic or otherwise, sponsored by the Farmingdale Youth Council, Inc.

I/we agree with the above *

Signature:

Date:

* indicates required fields

Uniform Deposit($65)

Out of District Youth Council Fee Per Family($60)

Additional Child Discount($-10)

Payments Accepted By

Note: Credit Card information can be entered once this form is submitted