A Team Football Registration 2017

IMPORTANT INFORMATION: Registration Fee is $115.00 per child
Mandatory fundraiser participation or mandatory $60.00 fundraiser buyout.

Registration fee MUST be received within 7 days of completing registration online. Makes checks payable to: Willow Street Midget Football. If payment is not received, registration will be deleted to open the spot for another player.

Registration may close at anytime for a team which has reached our maximum team limit.

By registering my child with the program I acknowledge that participation in the fundraiser is MANDATORY and failure to participate will result in suspension of you player(s).

Information below is requested for proper player team placement. Players will be placed on teams according to the Red Rose League Age and Weight Requirements, see the Red Rose League link on the home page for requirements. First year players are required to provide Red Rose League a copy of their birth certificate, the copy must be submitted with their registration payment. All players are required to have a yearly physical before the start of the season, the Red Rose Contract must be signed by the doctor's office. The concussion form must be printed, signed and sent with payment. These forms can be found under "Handouts" on the website.

Football Player Information

Parent/Guardian #1

Parent/Guardian #2
Medical Information

Waiver and Release:

I certify that my child has no physical or mental condition or disability subjecting him/her to any undue risk from such participation.

The below named parent and/or guardian hereby requests that the above named child participate in the program sponsored by the Willow Street Midget Football, and consideration of such participation and intending to be legally bound hereby, said parent and/or guardian of child on his/her behalf hereby releases, discharges, and indemnifies Willow Street Midget Football Program and/or pertinent leagues, their successors, assigns, officers, and employees from all liability for injury to the person or damage to the property of himself and child. This release and indemnification shall bind parent and/or guardian, his/her spouse, heirs, and legal representatives.

I understand that the equipment issued to my son/daughter by Willow Street Midget Football, unless otherwise stated, is the property of the Willow Street Midget Football Program and shall be returned to the program cleaned and in reasonably the same condition as issued, at the conclusion of the "season" or at such time as requested by a program official. I understand that failure of my child or myself to comply with the above stated Equipment Policy may result in the assessment of an appropriate fee, payable by me to the program, for the purpose of cleaning and/or replacement of the issued equipment.

I have read and agree that any individual associated with the player will abide by the "Zero Tolerance" Code of Ethics Policy, located in the Handout Page, as set up by the Willow Street Midget Football/Cheerleading Board of Directors. I realize and will inform any individual associated with the player that any violation of this policy will result in the stated suspensions. I understand that all of the coaches are volunteers and need to be treated with respect for their willingness to share their time and knowledge of the game of football/cheerleading with our children. The Zero Tolerance Policy may be downloaded from this site.

I acknowledge that I am required to sign up for 2 volunteer spots per season during home football games. I will be required to do this before my child is allowed to receive equipment or participate in practice. If am unable to fulfill my volunteer slot, I am required to find a replacement and notify the Volunteer Coordinator. If the slot is not filled, I am subject to a $25 fine to be assessed immediately.

I acknowledge I am required to print Red Rose Player Contract from the Handout Page and schedule my child's physical prior to July 29, 2017. This form must be signed by the doctor and turned in at equipment pick up. Failure to do so may result in my player not receiving equipment. The Red Rose Player Contract can be found at under the "Handouts" section.

I acknowledge I am required to print and sign (both parent & player)The Concussion Form under the "Handouts" Page on this site.
The Safety in Youth Sports Act requires athletes and a parent or guardian to annually read and sign a concussion and head injury awareness sheet before the student participates in practice or competition. The information sheet will include materials from the Centers for Disease Control and Prevention's Heads Up program. Under the new law a player who exhibits symptoms of sustaining a concussion would be removed from play and would not be able to return to play until cleared by an appropriate medical professional. Coaches, trainers, physicians, physical therapists and game officials would be authorized to remove players for suspected head injuries and would be protected from civil liability for doing so.

I acknowledge that my child and myself as their parent/guardian will read and sign the concussion and head injury awareness sheet located in the handout section. The sheet will be turned in by equipment handout night.

I acknowledge that my player's name may be listed on the Willow Street Football & Cheerleading website along with practice and game schedules.

Willow Street Midget Football does authorize a photographer(s) to take pictures during games and may solicit the pictures to members of the organization. I authorize the release of my child's picture to the authorized Willow Street Photographer(s).

I acknowledge that I am required to mail the player registration fee within 7 days of submitting this form. If I do not mail payment, my player's registration may be deleted. There will be an additional charge $35 Insufficent Check Fee, if applicable.

Registration Fee Refund will be granted til July 1, 2017 by emailing willowstreetfootball@gmail.com. After July 1st, registration fee is non-refunded.

Please mail payment to Willow Street Football,

PO Box 183
Lampeter, PA 17537
Questions: email willowstreetfootball@gmail.com

By checking the below box, this is my electronic signature that I agree to all of the above information and I certify all information listed above is accurate and correct.

* required