2016 SB United Online Football Registration Form

Please complete and submit the following Registration and Consent and Release forms.

PLAYER INFORMATION
* Player First Name:
* Player Last Name:
* Street Address:
* City:
* State:
* Zip:
* Date of Birth:
* Grade Fall 2016:
* What school will player attend starting Fall 2016?:
* Height (inches):
* Weight (lbs):
* Did you play tackle football last year?:
If you played last year, what League?:
T-Shirt Size:
What Position/Positions?:

PARENT OR GUARDIAN INFORMATION
* First Name:
* Last Name:
* Parent Address- Same as Child:
Street Address:
City:
State:
Zip:
* Home Phone (###-###-####):
* Cell Phone:
Cell Phone 2:
Work Phone:
* Email Address #1:
Email Address #2:
Are you interested in Volunteering for any of the following?
Coaching  
Concession Stand Coordinator  
Concession Stand Volunteer  
Team Mom  
First Down Chains  
Admin  
Spirit Sales  
Home Game Announcer  
Article Writer  
Photographer  
Other  


SB UNITED YOUTH FOOTBALL CONSENT AND RELEASE
* Player's Primary Medical Insurance Carrier:
* Name of Policy Holder:
* Policy Number:
* Physician's Name:
* Physician's Phone Number (###-###-####):
* Emergency Contact Name:
* Emergency Contact Number (###-###-####):

I, the undersigned certify that I am the parent or Guardian of the above named child. I do hereby consent to participation in the SB United by our child/ward. I acknowledge that his/her participation is under the jurisdiction of the organizers, sponsors, officers and managers of the organization. I hereby hold harmless and release the said organizers, sponsors, officers, managers and coaches of the SB United from any and all claims or actions whatsoever based on my child or myself as a participant or spectator in the normal course or participation in the designated sport and the activities incidental thereto.
I HEREBY GIVE CONSENT FOR ADMISSION TO THE TREATING HOSPITAL OF MY CHILD IF IN THE JUDGEMENT OF THE ATTENDING PHYSICIAN IT IS NECESSARY FOR ANY TREATMENT HEREIN.
* PLEASE INITIAL HERE:
This consent is to be effective only after reasonable efforts have been made to contact me and obtain my consent to any emergency treatment. I hereby authorize our designated emergency physician and/or their designated associates or assistants or their covering physicians or in the event these persons cannot be contacted the emergency physician on duty at the emergency center to provide emergency treatment to our child/ward. No major surgery or life-threatening procedures may be performed upon my child/ward and no general anesthesia may be administered unless: the life or health of my child/ward is in imminent danger or delaying such treatment to obtain consent would create a threat of serious injury to the heath of my child/ward or the attending physician and one other physician consult and agree that such treatment is necessary for the health of my child/ward.
By entering my name below I accept all of the terms of this Consent and Release form.
* Please enter Parent /Guardian Name:


SB United Image Release Form - Player

READ BEFORE SIGNING

In consideration of MY CHILD LISTED BELOW, my minor child/ward being allowed to participate in any way, in any Somerville Branchburg United Youth Football (SB United) events and activities, the undersigned agrees that SB United and American Youth Football Inc., are hereby granted the unrestricted right and permission, free from approval or review, to copyright and/or use my child's/ward's likeness in all media now or hereafter known, including but not limited to, pictures and videos of my child which he/she may be included intact or in part for promotion or other commercial use.
* PLAYER NAME:
* PARENT NAME:
By entering my name below I accept all of the terms of this Image Release form
* PARENT SIGNATURE:

Registration fees are as follows:

We offer a Sibling Discount of $25 to be applied to children registered in the SB United program AFTER the first child.

Travel Flag - K-2nd Grade: - $150

Tackle - 3rd-8th Grade: - Register by JUNE 12, 2016 - $225. AFTER June 12, 2016 - $250



In order to submit the form and choose your method of payment, please select the appropriate registration fee from the drop down box below and then select the "Submit" button.

If you need to add another player, you will be prompted to do so on the next page and will be required to select a fee for that player after completing the form.

After selecting the "Submit" button, you will be given the opportunity to pay using a credit card or an existing Paypal account or to print your registration/consent form and mail your check.

Also, after selecting the "Submit" button below, you will receive an email confirmation of this registration.

Please mail check to SB United Youth Football
P.O. Box 5103
North Branch, NJ 08876


* required


Select the Appropriate Registration Fee

Payments Accepted By

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