Participants Name:________________________________________________________________________________
Address_____________________________City________________________________________________________
Zip Code___________ Shirt Size(YS-AXXL)_________ Pants Size(YS-AXXL) _____________________________
Date of Birth:_______________ Phone Number:______________________________________________________
Age at July 31, 2009_______Grade for 2009_______Birth Cert. Attached_____________________________
Weight at date of registration_________________________________
Registration fee - $590 check made out to Glencoe Football Association attached -_____________
Parents Information
Address:_________________________________ City_________________ Zip:___________________________
Home Phone: (M)________________ Cell:__________________________Work:_________________________
Home Phone:(F)_________________Cell:__________________________Work__________________________
Custodial Parent: YES_______ NO_______
Email Address(es):(M)________________________________________________________________________
(F)______________________________________________________________________
Parental Medical Treatment Authorization
I the Custodial parent/Legal guardian, give the staff of Glencoe Football Association permission to administer appropriate emergency medical attention to my child in the event of any accident, illness, or injury which occurred during any football practice and scheduled GFA function including the supervised travel to and from said functions. I also authorize any hospital, paramedic and or physician to administer appropriate emergency medical attention for any accident, illness or injury which occurs at any scheduled GFA function including the supervised travel to and from said functions.
PARENTS INITIALS_____
Medical Information
Does the participant have any serious injury, illness, allergies or any other Medical condition that would prohibit participation in GFA activities?
NO_______ YES_______ If Yes the Participant must have a Medical Examination/release form completed by a physician.
REFUND POLICY
50% refunds are given from registration day until
CONSENTS AND LEGAL PROVISIONS
· I, the Parent/Guardian, understand that if my child’s team/squad qualifies for post season activities including but not limited to National football and cheer events, I will be responsible for all travel and room and board expenses.
· I, the Parent/Guardian, understand that my child’s specific level of participation will be determined by GFA based on Chicagoland AYF guidelines, child’s safety and the best interest of the child.
· I, the Parent/Guardian, understand that GFA highly stresses the importance of academic performance. To be eligible for academic awards I will furnish GFA with my child’s final report card from the previous year by June 30th.
· I, the Parent/Guardian, AGREE to release photos of my child, AND MY CHILDS NAME, to be used on the GFA website and for promoting the Glencoe Football Association at fundraising events.
· I, the Parent/Guardian, agree to attend the Mandatory Parent Meeting and agree to abide by the GFA policies.
· I, the Parent/Guardian, agree to volunteer for two (2) games if necessary.
I, the parent or guardian, certify that all medical information provided by me is true and accurate to the best of my knowledge and have read the above Waiver of Liability and Legal Provisions and fully understand and accept its terms.
Printed Name of Custodial/Legal Guardian_____________________________________________________________________________
Signature/Date______________________________________________________________________________________________
