Stevens Point Youth Area Football Registration

www.stevenspointyouthfootball.com
Attention: All Kids Entering 3rd, 4th, 5th, & 6th Grades
Registration Dates: Please see our website listed above for dates and times
Where: SPASH - Field House, 1201 Northpoint Dr. Stevens Point
Cost: $115

Athlete Information

Save & Return

Save your progress and complete this form later. (optional)

Player First Name *

Player Last Name *

Age *

Weight *

Date of Birth (06/08/2002) * 🛈 +

Street Address *

City *

Home Phone *

Grade In Fall *

School *

School District *

Request to be on a specific team due to car pooling.

Have you played YAF in previous year? *

Yes

If Yes, Team Name

Referred by (if applicable), see website for details on our refer a buddy program:

Sports Physical in 2015 *

Yes

Other sports athlete is participating in during football season?

Parent/Guardian Information

Primary Parent/Guardian Name *

Primary Parent/Guardian Address (if different from above)

Primary Parent/Guardian cell phone *

Primary Parent/Guardian Email Address *

Primary Parent/Guardian Employer

Employer Phone Number

Secondary Parent/Guardian

Secondary Parent/Guardian Address (if different from above)

Secondary Parent/Guardian Cell Phone Number

Secondary Parent/Guardian Email Address

Secondary Parent/Guardian Employer

Secondary Parent/Guardian Employer Phone Number

Can You Help?

In what capacity are you available to help?

Head Coach

Assistant Coach

Board of Directors

Parent/Guardian Permission Statement

I hereby give my permission for my child, listed above, to practice and complete in the Youth Area Football Ltd. Program.
I further grant permission for any medical records pertaining to the health of the above named athlete be made available, if necessary, to Youth Football officers.

Parent/Guardian Signature *

clear

Todays Date * +

Please complete this registration form and bring registration fee with you to register.

Late registration will be accepted only as space on team allows. $15 Late Registration fee will be charged.
Player must register in person. Do not return registration to grade school.
Financial Scholarships available – Contact a Board Member for details.

Emergency Medical Treatment

As parent or guardian of *

I give my permission to allow medical treatment. This treatment is for any emergency (illness or injury) occurring during a Youth Area Football Ltd. activity when I cannot be reached to give consent.

Family Doctor

Telephone

Family Dentist

Telephone

Unusual Health Conditions *

Yes

Please Explain Unusual Health Conditions *

Takes Medications Daily *

Yes

Please Explain Daily Medications *

Has Allergies *

Yes

Please List Allergies *

Parent Guardian Signature *

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Todays Date * +

INSURANCE CERTIFICATION STATEMENT

My child has primary health insurance with *

Policy Number *

I understand that he/she will also be covered by a secondary policy with the Youth Area Football Ltd.

Parent/Guardian Signature: *

clear

Todays Date * +

MINOR WAIVER AND RELEASE OF LIABILITY

In consideration of being allowed to participate in any way in Stevens Point Youth Area Football athletics/sports program, related events and activities, the undersigned:

1. Agree that the parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition(s) and refuse to participate
2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence, but the action, inaction, or negligence of others, the rules of play, or the conditions of the premises or of any equipment used. Further, that there may be other risk not know to us or not reasonably foreseeable at this time.
3. Assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death.
4. Release, waive, discharge and covenant not to sue Stevens Point Youth Area Football, its affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organizations, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as “releases”, from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise.
5. Release the use of any photographs still or motion of the above signed athlete.
6. Allow Youth Area Football to share player contact information with other area youth athletic organizations.

WE HAVE READ THE ABOVE WAIVER AND RELEASE, AND UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.

Parent/Guardian Signature *

clear

Relationship *

Todays Date * +

Parent & Athlete Agreement

As a Parent and as an Athlete it is important to recognize the signs, symptoms, and behaviors of concussions. By signing this form you are stating that you understand the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury.

Parent Agreement:

Parent/Guardian's Name *

Todays Date * +

I have read the Parent Concussion and Head Injury Information and understand what a concussion is and how it may be caused. I also understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a concussion is suspected.

I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me.

I understand that my child cannot return to practice/play until providing written clearance from an appropriate health care provider to his/her coach.

I understand the possible consequences of my child returning to practice/play too soon.

Parent/Guardian Signature *

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Athlete Agreement:

Athlete's Name *

Todays Date * +

I have read the Athlete Concussion and Head Injury Information and understand what a concussion is and how it may be caused.

I understand the importance of reporting a suspected concussion to my coaches and my parents/guardian.

I understand that I must be removed from practice/play if a concussion is suspected. I understand that I must provide written clearance from an appropriate health care provider to my coach before returning to practice/play.

I understand the possible consequence of returning to practice/play too soon and that my brain needs time to heal.

Athlete Signature *

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Questions and Contact Information:

Other:

Name of Current Team

Have you ever had a concussion? *

Yes

If yes, how many?

Have you ever experienced concussion symptoms? *

Yes

If yes, did you report them?

Emergency Contacts:

Name *

Relationship *

Phone Number *

Name *

Relationship *

Phone Number *

Payment

Registration Fee *

Youth Football Player($115.00)

Coupon Code

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