Last Updated: November 25, 2016
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Fall 2016 Garnet Youth Football

* First Name:
* Last Name:
Street:
* City:
Zip Code:
* Birthdate:
Gender:
* Grade:
* Fall 2015 Football Team?:

PARENT/GUARDIAN #1
* Firstname:
* Lastname:
* EMail:
* Cell Phone:

PARENT/GUARDIAN #2
Firstname:
Lastname:
Email:
Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION
* Emergency Contact:
* Phone:
* Relationship to Player:
* Insurance Carrier:

* Policy #:

WAIVER INFORMATION
I, as parent of the above name participant registered in Garnet Youth Football, hereby give my approval and consent for participation in any and all activities.

In case of an emergency, if my family physician cannot be reached, I hereby authorize that my child, the above named participant, be treated by qualified personnel or another qualified, licensed physician.

I assume all risks and hazards, incidental to such participation including transportation to and from activities. I hereby waive, release and absolve, indemnify and agree to hold harmless, Garnet Youth Football, the organizers, supervisors, participants and person transporting my child to and from activities, for any claim arising out of injury whether to the result of negligence or for any other case, except to the extend and in the amount covered by accident and/or liability insurance.

I give permission for my child’s picture to appear on the Garnets Youth Football website or any other media outlet.

I am responsible for all equipment and uniforms loaned to my child. Uniforms not returned will result in an equipment fee.

$125 Registration fee includes 5 tickets ($10 per ticket) for Applebees breakfast - date/time tbd. You keep the money for tickets you sell/use.

I/we agree with the above   *

* required


Registration fee

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