COACH BRAD Football.

409-498-3375

Coach Rayya Honeybees

409-454-1462

Special Note: This form must be completed thoroughly and honestly, and signed by the youth participant’s parent or legal guardian. It is to be completed and dated after January 1, 2024. This form applies to the 2024 Fall – 2025 Spring season and needs to be submitted to your LOCAL Pop Warner organization. This form and its contents will be available to authorized Pop Warner personnel and kept confidential. By signing this form, the parent or legal guardian agrees to the terms and conditions outlined below.

League: GULF COAST POP WARNER.

Association: PORT ARTHUR JR BEES

Section II: YOUTH PARTICIPANT INFORMATION (must match birth certificate)

Primary Contact: Parent or Guardian

Secondary Contact:

The purpose of the above information is to ensure that medical personnel have details of any issues which may interfere with or alter medical treatment.

Recognizing the possibility of serious injury, illness or death, and in consideration for Pop Warner Little Scholars, Inc. and its members accepting my child as a participant in its official programs, I consent to my child participating in Pop Warner tackle football, flag football, cheer and / or dance. Further, I hereby release, discharge, and otherwise indemnify Pop Warner, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my child as a result of participating in the Pop Warner programs.

My child has received a physical examination by a licensed health care provider within the past two years and has been found physically capable of participating in the sport of football and/or cheerleading & dance. I have provided written notice, which is submitted in conjunction with this release and attached hereto, setting forth any specific issue, condition, or ailment, in addition to what is specified above, that my child has or that may impact my child's participation in the programs. I give my consent to have an athletic trainer and/or licensed health care provider, including a medical doctor or dentist, provide my child with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.

Section V: PARENT/GUARDIAN PERMISSION AND WAIVER

PERMISSION: I am the parent or legal guardian of the above-named participant. I acknowledge that my child is in good health. I give permission for my child to participate in any and all Pop Warner national, regional, league/conference, association and team/squad activities, including transportation to and from the activities. I give permission for, and assume any and all risk of my child's use of various playing surfaces including natural and artificial grass, cheer mats, hard dirt, and under varying conditions, including, dry, wet and muddy, and I hereby understand that any surface may be regular or irregular. RISK INFORMATION: I acknowledge the inherent risk and danger of participation in any sport and I

understand that participation in football, cheerleading and/or dance may result in BODILY INJURY, including by

not limited to PARALYSIS, BRAIN INJURY, PERMANENT DISABILITY AND/OR DEATH. I acknowledge

that protective equipment does not prevent all participant injuries and Pop Warner makes no representations or warranties regarding the equipment or its fitness for use. I release, indemnify, hold harmless and waive any claim against the coaches, local, league and regional Pop Warner organization(s), Pop Warner Little Scholars, Inc., and any and all organizers, sponsors, supervisors, participants, and persons transporting my child to and from activities, for any injury to my child whether the result of negligence or for any other cause.

3. EMERGENCY MEDICAL AUTHORIZATION: I give permission for emergency medical/dental treatmentor first aid to be administered to my child for any illness/injury/accident resulting from participation in PopWarner activities.

4. EQUIPMENT RESPONSIBILITY: I acknowledge my responsibility for any and all equipment/uniformsloaned to my child and I agree to promptly return, upon request, the uniform and other equipment in goodcondition except for normal wear and tear. If I fail to comply, I will be responsible for the cost of suchequipment/uniform.

5. INSURANCE DISCLOSURE: I am aware that my local Pop Warner organization carries group accident medicalinsurance which is secondary or excess to my insurance which is considered primary insurance. Further, I agree tonotify in writing my head coach and local Pop Warner organization of any medical claim from participation in PopWarner as soon as reasonably possible. I understand that the registration fee is not premium for insurance and thatdeductibles may apply.

6. SCHOLASTIC FITNESS: I confirm that my child is scholastically fit, having met the requirement of 2.0/70%,or that I have completed the scholastic eligibility form or the Home School Eligibility Form and will adhere to all rulesand regulations therein. Further, I authorize my child’s school to release grades, report cards, and all other scholasticinformation to the local Pop Warner organization in order to comply with scholastic fitness requirements.

7. FINANCIAL RESPONSIBILITY: I acknowledge that my rights, if any, to a refund depends on the localPop Warner Organization policies, and I have also been advised of my fundraising obligations for the entireseason and agree to fully comply with those obligations.

8. COMMUNICATIONS, PROMOTIONS, AND CONSENT: As a condition to my child’s participation, I consentto receive communications by email and mail from Pop Warner Little Scholars, Inc. and its sponsors. I understandthat Pop Warner Little Scholars does not sell its contact list. Communications may contain program information orspecial offers. I may “opt out” by instruction in the communication or by my written request to the Pop WarnerNational Office. Further, I grant Pop Warner the right and permission to make, reproduce, broadcast or otherwise usein perpetuity my child’s name and likeness including photograph, films, videos, recordings, or other depictions orimages in any form or media throughout the universe, for promotional material, advertising, editorial, trade or otherpurpose. To the extent that any benefit may accrue therefrom, I forever waive any interest in or claim to such benefitand acknowledge that Pop Warner is under no obligation to exercise any rights granted herein.

9. ADHERENCE TO POP WARNER RULES AND PROCEDURES: I understand that it is my responsibility tocomply with all rules and regulations of Pop Warner Little Scholars Inc and its affiliated organizations and understandthat non-compliance may be cause for discipline and/or dismissal of my child, myself, and/or other persons affiliatedwith me or my child. I further understand that my child must meet Pop Warner age and/or weight requirements ontheir official certification date as established by Pop Warner without exception and that the decision of the WeighMaster is final. I agree to furnish an authentic certified copy of my child’s birth certificate to local Pop Warner officialsand understand that valid proof of age, a current calendar year’s signed medical form, scholastic fitness form and thisform must be presented by date of certification in order to participate in Pop Warner activities. I hereby hold PopWarner harmless of any financial loss as the result of any disciplinary action.10. DISPUTE RESOLUTION POLICY; SEVERABILITY: I understand and acknowledge that all disputes withPop Warner and all affiliated parties will be subject to binding arbitration in Langhorne, PA in accordance withPennsylvania law. I hereby agree that this binding arbitration shall be in lieu of any litigation. I also understand andagree that if I contest any decision or ruling of Pop Warner and seek other recourse, that I will reimburse Pop Warnerfor all legal fees and expenses it reasonably incurs. If any portion of this form shall be deemed unenforceable, thereminder shall remain in full force and effect.

1/25/2024 PWLS, INC.

2024-2025 PARTICIPANT CONTRACT AND PARENTAL CONSENT FORM1/25/2024 PWLS, INC.Section VI: GENERAL CODE OF CONDUCTPop Warner Little Scholars, Inc. is committed to cultivating a safe and welcoming environment for its regional andnational events and programs that encourages and promotes good sportsmanship by student-athletes, parents,coaches, administrators and other spectators. We ask that event participants and attendees cooperate in beingrespectful at all practice and competition venues, partner hotels and/or ancillary venues throughout the course ofthe event. All those involved with the event are expected to refrain from the following behaviors:

1. Acting in a way that is unruly, disruptive or illegal in nature.

2. Intoxication or other signs of impairment that may potentially result in bad behavior.

3. Excessive use of profanities and other vulgar language that that interfere with other attendees’ ability toenjoy the event.

4. Using bigoted, demeaning or abusive or other disruptive and intimidating language and/or gestures.

5. Verbal or physical harassment of officials, participants and coaches before, during and following thecompetition.

6. Disrupting the progress of competition (including physically entering or throwing objects onto the playingfield or competition mat).

7. Interfering with or failing to abide by security or emergency procedures or response.

8. Displaying signs that contain offensive language, or any graphic art that may be deemed disrespectful.

9. Defacing, destruction or theft of property associated with the event, including property of the opposingteam or other participants, including officials, as well as official venues.

10. Violence or threats of violence against other individuals at any official venue.

11. Publicly criticizing or making derogatory statements of an official, opposing teams, event personnel or itspolicies, or other individuals associated with the event. This includes comments with respect to theirconduct, character, competence, integrity or appearance. Note: social media is deemed a public forum.

12. Failing to follow instructions of event personnel.

13. Any behavior which otherwise violates conduct codes set by partner venues, hotels or ancillary venuesincluding but not limited to theme parks, as enforced by those properties.Failure to abide by these expectations are grounds for removal from competition. Pop Warner reserves the right toremove individuals or the entire team. Depending on the infraction, a one-year ban from Pop Warner events andprograms will be considered. A repeat offense of the same infraction may result in a permanent ban. All removalswill be without refund.

Section VII: PARENT/GUARDIAN AUTHORIZATION:In consideration of participation in Pop Warner activities and by my signature below, I confirm that I have read,fully understand and voluntarily agree to be bound by all of the above and that all information provided by me istrue and accurate

1/25/2024 PWLS, INC.

After you complete this form, you will be transmitted to the Participant Contract and Parental Consent Form