2023 Football & Cheer Registration and Medical Release Form

2023 Football & Cheer Registration and Medical Release Form

DeSoto Jets Youth Association - Football & Cheer
Today's Date

MonthDayYear
Date
Child / Participant Info
Program*
Please select the program you would like to register for
Child / Participant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age as of August 1st 2023*
School*
Grade as of Fall 2023*
Jersey Number*
Parent / Guardian Info

Please enter your parent / guardian information below
Parent / Guardian Name*

First NameLast Name
Parent / Guardian 2 Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact Info

Please tell us who we should contact in case of emergency
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
(This person will be contacted should an emergency arise and we cannot contact the parent, or if there is a delay in picking up the child)

I, the parent or guardian of the above-name child, assert that my child meets the requirements of the DeSoto Jets’ Youth Association rules of eligibility. ELIGIBILITY IS SOLELY BASED ON CURRENT RESIDENCY. Any deviation from these eligibility provisions must be pre-approved by DeSoto Jets. Must read and sign refund policy and code of conduct, before your child can play. ALL fees need to be paid in full before weigh-in or child will be unable to play for DeSoto Jets and no refund will be given.

As the parent or guardian of the above name child, give my approval for his/her participation in any and/or all DeSoto Jets’ activities. I do hereby waive, release, absolve, indemnify and agree to hold harmless DeSoto Jets’, members of the Board, coaches, sponsors, supervisors, participants, and any persons connected. This is to certify that if either parent or guardian of the above named child is not present at any DeSoto Jets’ activities (practice, official league play or other activities), and this child is hurt as a result of accident, injury, or illness, I hereby grant permission to the adult manager, coach, or other DeSoto Jets’ representative to obtain medical care from a licensed physician, hospital, medical clinic, or EMT for this child, at such time as either parent or legal guardian cannot be contacted in person or by telephone. This authorization shall include all activities including the period required to travel to and from those activities. As parent or guardian, I understand DeSoto Jets’ philosophy to install good sportsmanship, and I agree to exhibit good sportsmanship and to abide by all rulings of the official in charge at any activity. I give permission for any photographs taken during these activities to be used for the promotion of DeSoto Jets’ in the future.
Signature*

Clear
Date*

MonthDayYear
Date
For Office Use Only

Please do not complete any info in this section
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Fees Paid
Payment Method
Receipt
Proof of Eligibility
Should be Empty:

2023 Football & Cheer Registration and Medical Release Form

Child / Participant Info

Parent / Guardian Info

Emergency Contact Info

For Office Use Only