I/We the parents/guardian of the below named child who is a candidate for a position on a Rockland Youth Football/Cheerleading team do hereby give my/our approval to participate in any and all of the activities of the league during the current season.

 I/We the parents/guardian do assume all risks and hazards incidental to the conduct of the activities and transportation to and from the activities.

 I/We do hereby release, absolve, indemnify and hold harmless the Rockland Youth Football Board of Directors, Coaches, Sponsors and or all of them. I/We likewise release from responsibility any person transporting my/our child to or from such activity.

I/We on behalf of our child accept responsibility for all equipment issued and to return said equipment in as good a condition as when received except for normal wear and tear. A cost or replacement may be incurred.

I/We will furnish a certified birth certificate upon request of league officials. No refunds of the registration fee will be made under any condition after the season starts.

I/We hereby indicate that I/We have family medical insurance (yes/no). Members of Rockland Youth Football are covered by medical insurance which is considered a supplement to family coverage and I/We agree to utilize our family medical insurance first.

I/We grant permission to coaching personnel or other league representatives to authorize and obtain medical care from any licensed physician, hospital or medical clinic should the youth become ill or injured, or transport said youth while participating in league activities away or at home or at other times when neither parent or guardian is available to grant permission and/or authorization for emergency treatment. I/We authorize Rockland Youth Football and Cheerleading staff to apply bug spray as they deem necessary.

I/We understand that RYF may use images of my child for promotional products such as our leagues website and fundraising events.

I/We understand that once registered for Rockland Youth Football & Cheerleading the organization takes on certain expenses. I/We understand that no refund will be given after registration has been accepted.

I/We understand that no player will be allowed to reregister for another season until fees for missing items have been paid.


As Parent or legal guardian of the above-named player, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being of my dependent.


Participants Name


Home Tel #

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Cell Phone #

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Parents Email:


Work Phone #

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Date of Birth:


School Grade



SIGNATURE PARENT/GUARDIAN: __________________________________     DATE:            /               /



Team:  _________________     Payment Method:  Cash  /  Check (circle one)  Amount: $ ____________