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Farmingdale Hawks
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Hawks On-line Registration
PLAYER INFORMATION
*
Childs First Name:
*
Last Name:
*
Street:
City:
State:
*
School:
Zip Code:
Home Phone:
*
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
*
Gender:
M
F
*
Grade:
K
1
2
3
4
5
6
7
8
9
10
11
12
PARENT/GUARDIAN
*
Firstname:
*
Lastname:
*
EMail:
Home Phone:
Work Phone:
*
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
Emergency Contact:
Phone:
Relationship to Player:
Insurance Carrier:
Policy #:
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,
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,
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,
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
*
* indicates required fields
SELECT FEE
$325 - 5-13 CHEERLEADING --(includes Registration + $80 Raffle Book fee)
$150 - 5/6/7 FOOTBALL (includes Registration + $80 Raffle Book fee)
$350 - 9 -13 FOOTBALL -Player has previous years Game Jerseys (includes Registration + $80 Raffle Book fee)
$450 - 8-13 FOOTBALL Player needs NEW home/away Jerseys (includes Registration + NEW Jerseys fee + $80 Raffle Book fee)
Out of District Youth Council Fee Per Family($100)