AMERICAN YOUTH FOOTBALL
Participation, Tracking and ID Card - All-American Division
PARTICIPANT NAME
Grade In Fall
AGE (7/1)
PARTICIPANT GUARDIAN NAME
HOME PHONE
I, Hereby, With My Signature, Do Certify That The Information Below Has Been Collected And Verified By The Means, As A Minimum, As Instructed In The AYF National Rulebook And/Or Operations Manuel, Current Version.
Age As of 7/1
INSTRUCTIONS: PLAYER CHECK Will Enter Date, Verify The Identity, Of Each Participant, Initial Each Participant Card, CODE: OK = Everything Verified, I = Sick/Injured, A = Absent / Dropped ALL MUST BE CHECKED IN / VERIFIED PLAYING OR NOT/ENTER DETAIL UNDER 'CODE'
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Participation Contract, Tracking and ID Card - Page 2
Participant Last Name
Participant First Name
Middle Initial
Preferred (nick) Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date Of Birth (M/D/YR)
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Month
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Day
Year
Date
Age as of 7/1
Parent/Guardian Name
First Name
Last Name
Grade in Fall
School in Fall
School Phone
Home Email Address
example@example.com
Medical Insurance (circle one)
YES
NO
Name Of Insurance Carrier (if none type Self Pay)
Policy # (if non type Self Pay)
What Sport are you playing this year?
Football:
Cheer:
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.
Parent/Guardian Initial:
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.
Parent/Guardian Initial:
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 Parent/Guardian Initial:
Player Initial:
I assume full responsibility for any and all equipment/uniforms loaned to my child/ward and I agree to promptly return, upon request, the uniform and other 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.
Parent Initial:
Parent Initial:
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.
PRINT Parents/Guardian Name:
Parents/Guardian Signature:
Date Signed:
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Month
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Day
Year
Date
NOTE: This form as with any and all forms used by your Association should be reviewed by your local counsel for compliance with any state or local statutes. This form should be kept on file for a minimum of 7 years.
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Emergency Medical Treatment, Consent and Information
The following information will be used in the event that a parent / legal guardian is not available. The purpose of this information is to provide a quick reference for medical personnel should the need arise. Please fill out this form completely. If a particular question is not applicable write "none", n/a, or other appropriate comment otherwise none will be assumed. If additional space is needed, please use the back of this form or attach additional pages as needed. All information disclosed here will be treated as confidential. It will be the responsibility of the parent/legal guardian to notify the participant's coach and league/event officials if any information needs to be added, deleted, changed, or updated in any way.
ATHLETE INFORMATION
Athlete's Name:
Nick Name:
Phone:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT OR GUARDIAN INFORMATION
Father's Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Hm Phone:
Daytime Phone:
Email:
example@example.com
Employer:
Mother's Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Hm Phone:
Daytime Phone:
Email:
example@example.com
Employer:
Guardian's Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Hm Phone:
Daytime Phone:
Email:
example@example.com
Employer:
FAMILY MEDICAL INSURANCE
Carrier:
Group:
Policy #: (If SSN type last 4)
Group #:
Policy Holder Name:
Family Physician's Name:
Dr's Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dr's Phone Number
Please enter a valid phone number.
Allergies:
Medical Conditions:
Parent / Guardian Name:
Parent / Guardian Signature:
Date
-
Month
-
Day
Year
Date
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AMERICAN YOUTH FOOTBALL Image Release - Minor ASSOCIATION NAME - ______________________________ READ BEFORE SIGNING In consideration of (insert child's name) _____________ , my minor child/ward being allowed to participate in any way, in the American Youth Football, Inc. ("AYF") (dba American Youth Football and American Youth Cheer,) national championships and any other official AYF events and activities, the undersigned agrees that American Youth Football Inc., 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.
Participants Name:
Parent / Guardian Name:
First Name
Last Name
Parent / Guardian Signature:
Date
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Month
-
Day
Year
Date
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AMERICAN YOUTH FOOTBALLWaiver and Release of Liability - MinorASSOCIATION NAME - ______________________________READ BEFORE SIGNINGIN CONSIDERATION OF_______________ , my child/ward, being allowed to participate in the American Youth FootballAmerican Youth Cheer Regional/National Championships, and or the football and or cheer programs of _______________, the Local Organization, which is a legally distinct and organization not operated or controlled by American Youth Football, despite its membership with American Youth Football, Inc. 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 agrees that: 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. Print Name of Parent/Guardian: ______________________________________________________________________Parent/Guardian Signature: ______________________________ Date Signed: ______________________________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. Print Name of Participant: _________________________ Participant’s Signature: ___________ Date Signed: _____________ NOTE: This form as with any and all forms used by your Association should be reviewed by your local counsel for compliance with any state or local statutes. This form should be kept on file for a minimum of 7 years, longer in the event of an injury. Please confer with your local attorney for advice as to the appropriate maintenance and storage term for this and all such forms.
Participants Name:
Parent / Guardian Name:
First Name
Last Name
Parent / Guardian Signature:
Date
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Month
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Day
Year
Date
Participant Name:
First Name
Last Name
Participant Signature:
Date
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Month
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Day
Year
Date
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AMERICAN YOUTH FOOTBALL Mild Traumatic Brain Injury (MTBI) / Concussion Statement and Acknowledgement Form I, _________________________ (athlete), have chosen to participate in an a sport where injuries may occur and I do understand that it is my responsibility to report all of my injuries and illnesses or suspected injuries and illnesses to the organization’s staff, including but not limited to: coaches, team physicians, and athletic training staff. I further understand and recognize that my health and safety is the most important thing and without disclosing all injuries and or illnesses, it can not be properly determined if you are in the physical condition necessary to participate. I understand that I must provide a full and accurate medical history including any symptoms, health complaints and any prior injuries and/or disabilities I have experienced before, during or after athletic activities. By signing below, I acknowledge: ● My organization has provided me with specific educational materials including the CDC Concussion fact sheet(http://www.cdc.gov/concussion) on what a concussion is and has given me an opportunity to ask questions. ● I ACKNOWLEDGE THAT I HAVE READ THE FACT SHEET on the CDC website for Parents and Players. ● I have fully disclosed to the staff any prior medical conditions and will also disclose any future conditions. ● There is a possibility that participation in my sport may result in a head injury and/or concussion. In rare cases, these concussions can cause permanent brain damage, and even death. ● A concussion is a brain injury, which I am responsible for reporting to the team physician, athletic trainer, coach, parent volunteer, or official. ● A concussion can affect my ability to perform everyday activities, and affect my reaction time, balance, sleep, and classroom performance. ● Some of the symptoms of concussion may be noticed right away while other symptoms can show up hours or days after the injury. ● If I suspect a teammate has a concussion, I am responsible for reporting the injury to the staff. ● I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion related symptoms. ● I will not return to play in a game or practice until my symptoms have resolved AND I have written clearance to do so by a qualified healthcare professional. ● Following concussion the brain needs time to heal and you are much more likely to have a repeat concussion or further damage if you return to play before your symptoms resolve.Based on the incidence of concussion as published by the CDC football and cheer, among other sports, have been identified as high risk for concussion.I represent and certify that I and my parent/guardian have read the entirety of this document and fully understand the contents, consequences and implications of signing this document and agree to be bound by this document.
Athlete Name:
Athlete Name:
First Name
Last Name
Athlete Signature:
Date
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Month
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Day
Year
Date
Parent / Guardian Name:
First Name
Last Name
Parent / Guardian Signature:
Date
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