North Caddo Youth Football Registration Form

North Caddo Youth Football League 2019- Registration Form

(age 12 and under)

Youth Football- Vivian Louisiana 71082

mrthomas7781@aol.com

Athlete Information

Athlete Name

First NameLast Name

AGE as of JUNE 1 2019

4-67-89-1011-12

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone*

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail*

Years playing football*

	1	2	3	4	5

1 is Begginer, 5 is Advanced

Interested in Volunteering while your team not playing?

RefereeOperate ScoreboardCoachingConcessions

Important Notes

· No kid shall practice and or play without waivers

· Registration fee must be paid before uniforms are issued

· Keep the fields clean

· The league organizers reserve the right to form the teams to ensure the talents of all teams are balanced.

· Fee: $45.00 per participant. All the money will be used for uniforms, insurance and banquet.

All player are reqired to purchase black football pants with pads.

I would like to play on the same team with following players. League organizers will form teams base on this buddy list and your skill level.

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo

Please describe*

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities at Youth Sport Center's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Youth Sport Center and the persons in charge.

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

Signature*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at gxtt.basketball@gmail.com.