Chautauqua Lake Youth Football

Chautauqua Lake Youth Football 2021 - Registration and Medical Release Form

(ages 6-12)

Mayville, NY 14757

For Questions, Call/Text Kyle at 716-499-3825

Email: LakeYouthFootball@gmail.com

Player Registration

Please fill out the registration form in its entirety.

You must complete a new form for each player.

Player Name*

First NameLast Name

Player Date of Birth*

Date

Height*

Weight*

Shirt Size*

Pant Size*

Number Preference #1

Number Preference #2

Number Preference #3

Does the player have any restrictions or medical conditions the league should be aware of? If yes, please explain.*

Parent/Guardian Name*

First NameLast Name

Player's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent / Guardian's Primary Phone*

Area CodePhone Number

Secondary Phone

Area CodePhone Number

Preferred E-mail*

example@example.com

Emergency Contact (other than name listed above)

First NameLast Name

Emergency Contact (other than number listed above)

Area CodePhone Number

Division Options:

1. Flag Football ages 6-8- $50

2. Rookie Tackle ages 8-10- $100 (plus $50 refundable equipment deposit)

3. Tackle ages 10-12- $100 (plus $50 refundable equipment deposit)

Ages are based on the age of the child on August 1st, 2021. Please mark "Unsure" if you are undecided or unsure where your child fits.

Flag FootballRookie TackleTackleUnsure

All players must have a birth certificate on file. You have the option to email to: lakeyouthfootball@gmail.com

Browse Files

If you prefer to upload a file rather than a photo, use this option.

All players must have a physical on file. Can not be more than 1 year old. You have the option to email to: lakeyouthfootball@gmail.com

Browse Files

If you prefer to upload a file rather than a photo, use this option.

Liability Waiver

I, parent/guardian of the registrant (a minor) agree that the registrant and I will abide by the rules of the Lakeshore Area Midget Football League and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with participating in youth football, I hereby release, discharge, and /or otherwise indemnify the Lakeshore League, its affiliated organizations, sponsors, their employees, and associated personnel including the owners of the fields and facilities used for the program against any claim by or on behalf of the registrant as a result of participation in the program and or being transported to or from the same.

Consent for Medical Treatment

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

YesNo

Confirmation E-mail*

example@example.com

Signature

Flag Football $50, check sent to: Lake Youth Football 6997 McKay Rd. Mayville, NY 14757Flag Football $50, Venmo: @LakeYouth-FootballRookie Tackle or Tackle $100, check sent to: Lake Youth Football 6997 McKay Rd. Mayville, NY 14757Rookie Tackle or Tackle $100, Venmo: @LakeYouth-Football

If you choose to mail a check, please add your child/children's names to the subject line.

If you choose to Venmo, you will need to complete that step outside of this form document. There is not an option to link Venmo through this form.

Thank you.

Additional Information:

No refunds will be given after the 2nd week of practice.
Must have 10 practice with full pads (if applicable ) before the first game
All parents/guardians are required to work at least 2 hours in the concession stand.
Players will be required to participate in fundraising activities for the league with an option $100 buyout for fundraising efforts.
Players and parents/guardians must follow COVID-19 mandated regulations.