Flag Football Registration Form
Participant's Name
First Name
Last Name
Participant's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Participant's Date of Birth (Month/Day/Year)
Participant's Age
Participant's Gender
Please Select
Male
Female
Non-Binary
Participant's Jersey Size
Please Select
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
XL
XXL
Participant's Shorts Size
Please Select
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
XL
XXL
Participant's Glove Size
Please Select
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
XL
XXL
Participant's School
Participant's Grade (2024-25 School Year)
Mother's Name
First Name
Last Name
Mother's Email
example@example.com
Mother's Cell Phone Number
Please enter a valid phone number.
Mother's Work Phone Number
Please enter a valid phone number.
Father's Name
First Name
Last Name
Father's Email
example@example.com
Father's Cell Phone Number
Please enter a valid phone number.
Father's Work Phone Number
Please enter a valid phone number.
Legal Guardian's Name
First Name
Last Name
Legal Guardian's Cell Phone Number
Please enter a valid phone number.
Legal Guardian's Email
example@example.com
Legal Guardian's Work Phone Number
Please enter a valid phone number.
Person Authorized to Pick Child Up (please include a copy of their ID)
*
ID Photo
Emergency Contact Name and Relation to Participant
*
Emergency Contact Phone Number
*
Does this participant have any health conditions we should be aware of?
*
Is this participant on any medication
*
Please Select
Yes
No
If the participant is on any medications, please list them here:
*
Participant Allergies (N/A if none)
*
Participant's Doctor
*
Doctor's Phone Number
*
Please enter a valid phone number.
Participant's Insurance Carrier
*
Insurance Policy Number
*
PARENTAL PERMISSION
You have our permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner, or other medical personnel to examine, interview, test, and if necessary, treat my child as they deem advisable.
Parent/Legal Guardian Name(s)
*
Parent/ Legal Guardian Signature
*
PHOTO RELEASE STATEMENT
I hereby give permission to Joel Gamble Community Outreach to photograph and/or videotape my child for educational and promotional purposes.
Parent/Legal Guardian Signature
*
Would you be interested in other JG Community Youth Outreach programs?
Please Select
Yes
No
CONTACT INFORMATION
For more information, contact: JGCYO by email at jgcomyouthoutreach@gmail.com
PARENT STATEMENT
I hereby state that my child is in good mental and physical health condition to participate in the activities provided by Joel Gamble Community Youth Outreach, including but not limited to all aspects of running, tumbling, and athletic training, football, jumping, diving and or competition. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of serious injury. I hereby release Joel Gamble Community Youth Outreach, and its staff from liability to the above named athlete, of the person claiming through him/her, arising from injury to the person or property of the above named athlete occurring at any event sponsored or sanctioned by Joel Gamble Community Youth Outreach and or travel to and from such activities. I understand that Joel Gamble Community Youth Outreach has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my son/daughter/child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior in or out of the league, etc.) or becomes involved in any activity or with any persons not associated with Joel Gamble Community Youth Outreach and that Joel Gamble Community Youth Outreach, has the right to send him/her home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of my knowledge. In addition, I have agreed to the policy and fee statement and agree to comply.
Parent/ Legal Guardian Signature
*
Date
-
Month
-
Day
Year
Date
*
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JGCYO Flag Football Participant
$
50.00
Quantity
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