MARBURY YOUTH FOOTBALL AND CHEER REGISTRATION

Name

Players First NamePlayer Last Name

DOB

Address

Street Address

Street Address Line 2

CityState 2 Zip Code

Fall 2025 Grade

School

Age as of August 1st

Football or Cheer

New Player

Years with MYFC

Parent/ Guardian Emergency Contact Information

Full Name

Relationship to Player

Cell Phone

Email Address

example@example.com

Full Name

Relationship to player

Cell Phone

Email Address

example@example.com

Physician Family Doctor

Phone Number

Insurance Carrier

Policy Number

Group Number

Allergies or Medical Conditions?

Print Name of Parent Guardian

Signature of Parent Guardian

Date

I, the parent/guardian of the named player/participant, hereby acknowledge that my child is ingood general health and I give my approval for my child to participate in any and all Marbury Youth Football and Cheer (hereinafter referred to as "MYFC") league/conference, regional, national, and team activities, including transportation to and from the activities by a licensed driver with proof of insurance. I agree to present a copy of my child's birth certificate (Football Players only.)

I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand that participation in football/cheer may result in SERIOUS INJURIES, PARALYSIS, PERMANENT DISABILITY, AND/OR DEATH. Furthermore, I fully acknowledge and understand that protective equipment does not prevent all participant injuries and therefore I do hereby waive, release, absolve, indemnify, and agree to hold harmless the MYFC organization(s), any and all organizers, sponsors, supervisors, instructors, coaches, and participants from any claim arising out of injury to my/our child whether the result of negligence or for any other cause.

2. EMERGENCY MEDICAL AUTHORIZATION

I hereby grant my permission for any and all emergency medical/dental treatment and /or first aid to be administered to my child/ participant including authorizing any medical treatment facility/hospital to administer emergency treatment for any illness/injury/accident resulting from participating in any and all MYFC activities.

Football: I agree to provide practice pants, socks, and cleats. The provided game jersey, pants, and socks are to be worn only to the games or for pictures. Helmets and pads can be rented before the 1st day of practice if needed. Cheer: I agree to provide practice clothing and athletic shoes. The provided game uniform, bloomers, wind suit, shoes, and bow are to be worn only to the games or for pictures. If my child does not have those items for practice or a game then they will not participate in that activity.

I do hereby grant my permission for the named participant to participate in any and all activities of MYFC. I assume all risk incidentals to such participation including transportation to and from all activities. I hereby waive, release, absolve, indemnify, and agree to hold harmless MYFC; it's league officials, respective coaches, other players, parents/guardians, sponsors, participants, volunteers, and any other persons transporting my child. I agree the named participant is fully covered under my insurance/health policy. Furthermore, I agree to notify in writing my head coach and any league board member of any medical claim caused by participation in any and all MYFC events or activities as soon as reasonably possible.

I hereby stipulate that my child is scholastically fit. Furthermore, I hereby authorize my child's school to release school grades, report card results, and any and all permanent scholastic information to MYFC organizations in order to comply with MYFC scholastic fitness requirements.

I hereby understand and acknowledge that as a parent/guardian of a MYFC participant, it is my responsibility to comply with all rules and regulations stipulated, adopted, or recognized by the MYFC organization. Any non-compliance with any and all rules and regulations may be cause for discipline and/or dismissal of my child (the participant), myself, and/or any spectators, or other persons affiliated with the named participant or myself.

I hereby grant MYFC the absolute right and permission to use my child's likeness in a photograph, video, broadcast, publish, or copyright and use pictures of my child in which he or she may be included in whole or in part, composite or retouched in character or form, without payment or any other consideration.

ParentGuardian Signature

Date