Interboro Golden Hornets Football

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Interboro Golden Hornets Football Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Birthdate:

* Age Division:

PeeWee (4-5 yrs old)

Freshman (6-7 yrs old)

Sophomore (8-9 yrs old)

Junior (10-11 yrs old)

Senior (12-13 yrs old)

* Gender:

* Name of School Attending:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

* Insurance Carrier:

* Policy #:

WAIVER INFORMATION

Contract
The undersigned, a legal custodial parent/guardian of the above name participant, hereby gives authorization for the participant in any and all activities coordinated by Interboro Golden Hornets Football Youth Organization. I assume all risks and hazards incidental to such participation including transportation to and from activities. I hereby waive, release, absolve, indemnify and agree to hold harmless the Interboro Golden Hornets, the Board of Directors, Coaches, Gloucester Township, Camden County Board of Education, Pine Hill Borough, Pine Hill Parks and Recreation, South Jersey United Football and persons coordinating activities on behalf of the participant form any and all liability, loss or damage my child may suffer as a result of personal injury, wrongful death, claims, demands, costs or judgments arising from child’s participation, except to the extent and in the amount covered by accidental liability insurance. Furthermore, I certify that I am not aware of any reason my child cannot or should not participate in the Interboro Golden Hornets program.
I understand that:
- Registration MUST BE PAID IN FULL prior to the issuance of game uniforms.
- No refunds will be issued after August 15th.
- You are responsible for any returned check. Check return fee is $35.00.
- I must participate in the mandatory fundraiser.
- All registration fees and mandatory fundraiser must be fulfilled to be able to participate in championships, all-stars, and awards banquet.
- Championship jackets are not included in the price of registration or mandatory fundraiser. Parents are responsible for costs of championship jackets.

Equipment Policy
Interboro Golden Hornets provides a seven piece pad set, shoulder pads, helmet, and custom game jersey, and game pants. Everything must be returned (except for the game jersey) at the end of your child’s last game. You will receive a $25 refund upon return of football equipment. Failure to return equipment will result in a collection fee of $300.00, or legal action for stolen property.

Photography Policy
At times photos of coaches and players will appear on our site. All images and text associated with our group page are the sole property of Interboro Golden Hornets and cannot be duplicated or used without the express written or verbal consent of the Interboro Golden Hornets Board of Directors. Parental consent for child to appear on website, unauthorized videotaping, and photography of Hornets players, coaches, officials, or other Hornets personnel for any reason is strictly prohibited.

Medical Information
By signing this form you have accepted all responsibility for any/all medical expenses incurred whether or not you are covered by insurance. As the parent/guardian of the participant named above, I request that in my absence, the named player by admitted to any hospital or medical facility for diagnosis and treatment. In case of injury, accident, or illness, I authorize a person from the Organization or volunteer to provide necessary medical treatment but, I agree and understand that the Interboro Golden Hornets are not responsible or liable for medical care deemed necessary. If an emergency transport is deemed necessary, I authorize the same to summon an ambulance to transport the player to the hospital. I request and authorize physicians, athletic trainers, technicians, first aid personnel, nurses, and dentists to perform any diagnostic, treatment, or operative procedure and x-rays for the named player. I have been given no guarantees as to the results of examination or treatment.

I accept total responsibility for any and all medical costs of the above named player.

I/we agree with the above *

* By typing your name here, you are verifying all information provided is correct and consenting to the contract above.:

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Interboro Golden Hornets Football Registration Form