2024 Tri-City Dolphins Player Registration

Tri-City Dolphins Player Registration
Player Name*

First NameMiddle InitialLast NameSuffix
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Date

MonthDayYear
Date
Qualifying Age Date

MonthDayYear
Date
Cutoff Date

MonthDayYear
Date
Current Age
Qualifying Age (July 1st)
Cutoff age( November, 27 2024)
Player Division
Current School Grade*
Current Height*
Current Weight*
Shirt Size - Please make sure to note if it is youth or adult sizing, i.e. Youth Large , Adult Medium*
Pants Size - Please make sure to note if it is youth or adult sizing, i.e. Youth Large , Adult Medium, Youth 18, Adult 32*
Has he/she played organized football before?*

YesNo
Please provide a current headshot of your child (from shoulders up). If you do not have one, please skip this step.*

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Parent/Guardian Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Would you like to add a second parent/guardian?*
2nd Parent/Guardian Name

First NameLast Name
2nd Parent/Guardian Email
example@example.com
2nd Parent/Guardian Phone Number
Please enter a valid phone number.

Emergency Medical Treatment, Consent, and Information
Medical Insurance Company*
Medical Insurance Number*
Preferred Hospital (if any)
Please provide your medical provider's name and phone number if you wish for us to contact them in the case of injury or illness.
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Please list any medical conditions (allergies, asthma, etc.) And medications being taken by the participant named above. Please list any other information you may deem relevant, and helpful to emergency medical personnel: (please note if no information is given and the words "none" or "n/a" is not filled in then, "none" will be assumed. Please make sure to list food allergies so that this can be passed on to parents when providing team snacks.*
I as evidenced below hereby grant permission for my child/ward to participate in any and all, Tri-City Dolphins youth football organization and, program(s) event(s), including but not limited to, athletic, social and/or fundraising activities. I further consent to the administration of any and all medical treatment necessary to stabilize and or treat any medical condition or medical emergency to which my child/ward is afflicted. I understand that this authorization is given prior to the need for medical care, but given in advance to avoid any unnecessary delay in emergency treatment which the attendant and/or medical professional may deem advisable in the exercise of their best judgment.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear
Date

Communication Permissions
Do you give permission to receive text messages related to the football organization? This may include announcements, reminders, and one-on-one text messages regarding your player and/or their team, as well as other organization related items.*
Do you give permission to receive emails related to the football organization? This may include announcements, reminders, and one-on-one text messages regarding your player and/or their team, as well as other organization related items.*

Image Release
In consideration of {playerName}, my minor child/ward being allowed to participate in any way, on the Tri-City Dolphins youth football organization and any other official Tri-City Dolphins events and activities, the undersigned agrees that the Tri-City Dolphins, is hereby granted the unrestricted right and permission, free from approval or review, to copyright and/or use my child's/ward's likeness in all media now or hereafter known, including but not limited to, pictures and videos of my child which he/she may be included intact or in part for promotion or other commercial use.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear
Date

Waiver and Release of Liability
IN CONSIDERATION OF {playerName}, my child/ward, being allowed to participate in the Tri-City Dolphins youth football organization, the undersigned acknowledges and agrees that:

The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,

1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and,

2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,

3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS American Youth Football, Inc.; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear
Date
UNDERSTANDING OF RISK

I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.
Participant Name*

First NameLast Name
Participant Signature*

Clear
Date Signed*

MonthDayYear
Date

Permissions and Acknowledgements
SCHOLASTIC FITNESS
I am of the opinion that my son/daughter/ward is scholastically fit and would benefit by participation in this program. I agree to submit a copy of my son/daughter/ ward's last completed grade, end of year/last complete report card or a written statement of scholastic fitness from the school administration.
PERMISSION TO PARTICIPATE
I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand that participation in football, cheerleading, dance and/or step may result in SERIOUS INJURIES, PARALYSIS, PERMANANET DISABILITY AND/OR DEATH. Furthermore, I fully acknowledge and understand that protective equipment does not prevent all participant injuries. I, the parent/guardian of the above-named participant, do hereby give my approval for my child/ward to participate, and further assert that I have verified with my child/wards physician, and in my opinion, my child/ward is physically fit and can participate without limitation in any and all Local, Regional, National, League/Conference, Association and team/squad activities, including transportation to and from the activities by a licensed driver.
HELMET WAIVER
We acknowledge, AND WE understand the risks involved in my CHILD/WARD, my playing FOOTBALL, which is a collision sport; the NOCSAE committee has adopted the following warning to be read by, and signed by, both the parent/guardian and participant.

DO NOT USE THIS HELMET TO BUTT, RAM OR SPEAR AN OPPOSING PLAYER,
THIS IS IN VIOLATION OF FOOTBALL RULES AND CAN RESULT IN SEVERE HEAD, BRAIN OR NECK INJURY, PARALYSIS OR DEATH AND POSSIBLE INJURY TO YOUR OPPONENT, THERE IS A RISK THAT THESE INJURIES MAY ALSO OCCUR AS A RESULT OF AN ACCIDENTAL CONTACT WITHOUT INTENT TO BUTT, RAM OR SPEAR, NO HELMET CAN PREVENT ALL SUCH INJURIES.
EQUIPMENT UNIFORM RESPONSIBILITY
I assume full responsibility for any and all equipment loaned to my child/ward and I agree to promptly return, upon request, the equipment in as good condition as when received except for normal wear and tear. If I fail to adhere to this policy, I will be responsible for and promptly pay the replacement cost of such equipment.
CODE OF CONDUCT
The ideology of youth sports including this program is to promote good understanding and fundamental knowledge of the sport. It is also critical that good sportsmanship including the ability to always conduct oneself in an appropriate manner of positive accord both on and off the field. It is understood that any incident considered detrimental to the pursuit of this ideology will not be tolerated. It will be addressed in accordance with the statutes of the association, conference, current national affiliation, state and local laws, and may result in dismissal from the program and the inability to participate in any future related activities of the association. This code of conduct applies to all involved with the program including but not limited to, the football players, cheerleaders, spirit participants, parents and guardians.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date Signed*

MonthDayYear
Date

Fees and Payments

Fees

The player registration fee is $225. This fee helps cover costs of player insurance, practice and game day fields, game day officials, end of season activities and administrative costs.

The player uniform package is $150. The uniform package includes two jerseys, two game pants, and one duffel bag.

Players must provide their own protective cup, cleats, girdle, chin strap and mouthguard.

Deposits

There is a $50 deposit due at the time of equipment checkout. Equipment includes shoulder pads, practice jersey's and helmets. This deposit may be made in the form of a post dated check, and will be returned at the end of the season when all equipment is returned. If shoulder pads and/or helmets are not returned, your deposit will not be refunded.

There is a $50 volunteer deposit. We require that all player’s families actively participate and support the organization by volunteering at least 4 hours of their time during the season. Volunteer hours can be fulfilled by helping in the snack bar, game day clean up, chain gang, recording player play count, banquet assistance, etc. The $50 deposit will be returned to the player once all four volunteer hours have been fulfilled. This deposit is required upfront and cannot be paid in the form of a post-dated check. Families may choose to surrender their deposit in lieu of volunteering their time.

Payments -There are 2 options for paying fees

Option 1: Pay in full at the time of registration ($375)

Option 2: A minimum payment of $150 must be made at the time of registration. This payment is required to ensure that uniforms are received prior to our first game.

A 2nd payment of $150 is due by May 15, 2024.

A final payment of your remaining balance($75) is due by July 15, 2024.

Refunds

Uniform fees are non-refundable.

Registration fees are refundable in the amount of 50% before July 24, 2024.

Registration fees are non-refundable after July 24, 2024.

Discounts

We are offering a $25 discount if registration is complete and all fees are paid in full by April 20th, 2024.

We are offering a sibling discount that will be applied to registration fees. Below is the discount in total to be applied to fees for a maximum of $150. All siblings will be verified through documentation.

1st sibling - $25

2nd Sibling - $75

3rd Sibling - $150

We are offering a $25 discount for referrals that sign up. This discount does not apply if your referral has been actively participating with the Tri-City Dolphins prior to April 1, 2024. The referral must register and pay the uniform fee before the discount can be applied. The discount will be applied to the referee’s registration cost.

The sibling discount and referral discount cannot be combined.

The paid in full discount may be combined with a sibling or referral discount, but not both.

Discounts will be applied to registration fees. Discounts cannot be applied to uniform fees.
I hereby acknowledge that I have read and agree to all of the fees, deposits, and terms above.
Parent/Guardian Signature

Clear
Date Signed

MonthDayYear
Date
Please list the full name of any players you have referred or any siblings that are signing up.

Player registration can be paid in full, or in installments with minimum payment of $150. *

Player registration fee - minimum payment of $150 required.Fees covers uniforms and registration. The minimum payment of $150 is applied to uniforms which are non-refundable.

$375.00 Quantity
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Tri-City Dolphins Player Registration

Parent/Guardian Information

Emergency Medical Treatment, Consent, and Information

Communication Permissions

Image Release

Waiver and Release of Liability

Permissions and Acknowledgements