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Registration - 2008 |
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Dublin Falcons website: www.dublinfalcons.com email: info@dublinfalcons.com --------------------------------------------------------------------------- FOOTBALL PLAYERS FEES: $250.00 *Plus the cost of Uniform & Equipment - $300 Deposit (Deposit checks will not be cashed unless equipment is not returned by deadline) CHEERLEADERS FEES: $75.00 *Plus the cost of Uniform & Equipment to be purchased by parents/guardians Contact Cheer Director or President for information ------------------------------------------------------------ ALL: There is a deposit this year of $ 100.00. (Checks will be cashed and refunded once you complete you 10 hours.) Parent/Volunteer participation make the program successful! ------------------------------------------------------------ 2008 REGISTRATION FORM (click here to download) or you may print out these pages. Player/cheer information (Name must match birth certificate or passport exactly.) Last Name ________________________________________________________ First Name _______________________ Middle Name ___________________ Address ________________________________________________________ City _________________________ Zip ______________________________ Phone (___)___________________ Weight at registration (Football only) ___________________________ Date of Birth ___________________ Age as of July 31, 2008 ____________
Have you participated in Delta League Youth Football or Cheer_____*(Y/N) or another youth football or cheer program ____ (Y / N)? If yes please list Team Name & City ____________________ and number of years participated _____________. PARENT / GUARDIAN INFORMATION - please fill out both, if parents live at different locations. PARENT(S) /GUARDIAN(S) Mother 's Name _______________________________________ Address ____________________________________________ City ____________________________ Zip ________________ Phone home (___)_______________ work (___)_______________ Cell/Pager (___)______________________________________ E-mail ______________________________________________
Father's Name________________________________________ Address ____________________________________________ City ___________________________ Zip _________________ Phone home(___)_______________ work(___)________________ Cell/Pager (___)_____________________________________ Email ______________________________________________ EMERGENCY CONTACTS (Please provide a Third Party Different From Above) Last Name _________________ First Name _______________ Phone home (___)________________ work (___)_______________ Cell/pager (___)___________________ other __________________ Address _____________________________________________ City _________________________ Zip ____________________
MEDICAL INFORMATION Family Doctor ________________________________________ Phone (___)___________________________________________ Name of Insurance Carrier _______________________ Group Policy # _________________________________ I.D. # _________________________________________ ALLERGIES ___________________________________ OTHER MEDICAL CONDITIONS _____________________________ ________________________________________________________
SECTION II - FINAL RESPONSIBILITY AND PARENTAL/PARTICIPANT CONSENT 1. I, the parent/guardian and/or signer for the above named child, do hereby give MY approval for participation in Delta Youth Football activities for the current season. I assume all risks and hazards to this participation for any claims arising out of injury to the above named child, including, but not limited to, transportation to and from such activities. I hereby waive, release, absolve, indemnify and agree to hold harmless, Delta Youth Football, the League, the Dublin/Tri-Valley Falcons team, organizers, managers, coaches, supervisors, participants, persons providing transportation and any organization with which this youth football program may be affiliated. 2. In executing the foregoing release, I acknowledge that I understand that our personal medical/dental insurance will remain the primary carrier, and that insurance offered through this program is secondary in nature and is subject to an annual deductible set by the carrier. I understand that any claims for injury arising out of MY/OUR child's participation must be reported to a Delta League association official within 30 days of injury. I understand the "Proof of Loss" must be completed in full and filed within 60 days of receipt by us. I understand that all monies paid to the team do not constitute payment of insurance coverage. I do indemnify Delta Youth Football, the association and the insurance carrier should there be statement(s) by "anyone" that is in contradiction. I certify I read and understand the terms of this "Contract" and any "Disclosure" information required. 3. I hereby grant authority to a qualified Emergency Medical Technician (EMT), doctor of medicine or physician to administer such medical treatment as said doctor or physician deems necessary under emergency circumstances. 4. Equipment Liability: Parent/Guardians and/or signer are responsible for return of all equipment and uniforms in good condition. I, the Parent/Guardian and/or signer will be responsible for reimbursement to the team/league for any cost of lost or excessively damaged equipment or uniform. 5. Media, Website Pictures & Names: I/We give permission to have my above named child's picture and name on the Dublin/Tri-Valley Falcons website; as well as to be submitted to Media outlets in conjunction for the promotion of the Dublin/Tri-Valley Falcons football and cheer program. I further acknowledge that I/We will not receive any compensation or fee for the use of said photographs/images.
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