2015 FLAG FOOTBALL
FALL REGISTRATION FORM
Division:
5-6
7-8
9-10
11-12
13-14
(Please circle one)
Child’s full name: ____________________________________________________________________________________________
Address: ____________________________________________________City_____________________ AZ
Zip________________
Best Contact Phone #: _______________________________Alternate Phone #: ________________________________
Email: ____________________________________________Alternate Email: _____________________________________________
Birth Date: ______________________ Age as of 8/1/2015: ___________ School Attending: __________________________________
Pictures allowed for any use such as Prime Time Athletics Website / Flyers / Facebook:
YES
NO
( Please circle one )
Physical Disabilities? YES ______ NO _______ (If yes, please explain)____________________________________________________
Father’s name: _____________________________________Mother’s name: _______________________________________________
Share same household: YES ________ NO ________ Communication needed for both parents: YES ________ NO ________
Interested in being Head Coach / Asst. Coach
Jersey Size:
Youth SM
Youth MED
( Please circle one )
Youth LG
Youth XL
Coach’s Birth Date: ___________________________
Adult MED
Adult LG
(please circle one)
Registration fees: April 11th=$99; April 12th-May 9th=$130; May 10th –Aug. 15th =$150; Aug. 16th –Aug. 31st =$170; Head Coach 1st
Child=$50.00
Payment due at time of registration: check #________ cash ______________ cc _________ total _________
•
Make check out to: Prime Time Athletics / Cave Creek
•
Address: 29834 N. Cave Creek #118-109
Cave Creek, AZ 85331
Coach Request _________________________________________ Friend Request __________________________________________
NO REFUNDS will be given after last day of registration
PARENT’S CODE OF ETHICS
I hereby pledge to provide positive support, care and encouragement for my child participating in sports by following this Parent’s Code of
Ethics Pledge.
• I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game, and practice. • I
will place the emotional and physical well being of my child ahead of a personal desire to win. • I will insist that my child play in a safe and
healthy environment. • I will support coaches and officials working with my child in order to encourage a positive and enjoyable experience
for all. • I remember that the game is for youth and not for adults. • I will do my very best to make youth sports fun for my child. • I will ask
my child to treat other players, coaches, fans and officials with respect, regardless of race, sex, creed or ability.
I promise to help my child enjoy the youth sports experience by doing whatever I can, such a being a respectful fan, assisting with coaching
or by being a good role model.
___________________________________________________________________
Parent / Guardian Signature
________________________________________
Date
RELEASE OF LIABILITY FOR MINOR PARTICIPANTS
READ BEFORE SIGNING
IN CONSIDERATION OF _________________________________________, my child or ward, being
allowed to participate in any in way in PRIME TIME ATHLETICS-related events and
activities, including but not limited to flag football leagues, football camps, cheerleading and football
practices (the “Events”), the undersigned acknowledges, appreciates, and agrees that:
1. The risk of injury to my child or ward from participation in the Events is significant,
including the potential for permanent disability and death, and while particular rules,
equipment, and personal discipline may reduce this risk, the risk of serious injury does exist;
and,
2. I for myself, my spouse, and my child or ward, and on behalf of our heirs, assigns, personal
Representatives, executors, administrators and next of kin, KNOWINGLY AND FREELY ASSUME ALL
SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE
RELEASEES (as defined below) or others, and assume full responsibility for my child or ward’s
participation in the Events; and,
3. I willingly agree to comply with the Events’ stated and customary terms and conditions for
participation. If I have any unusual or significant concern regarding my child or ward’s readiness for
participation or regarding the Events themselves, I will remove my child or ward from participation in the
Events and bring such concern to the attention of the nearest Prime Time Athletics official immediately;
and,
4. I for myself, my spouse, my child or ward, and on behalf of my/our heirs, assigns, personal
Representatives, executors, administrators and next of kin, HEREBY RELEASE AND HOLD
HARMLESS Prime Time Athletics Franchise Systems, LLC, and all of its franchisees and affiliates,
including but not limited to the franchise operating in my local area, in addition to all of the
aforementioned entities’ owners, directors, officers, officials, agents, employees, assigns and volunteers,
as well as other participants in the Events, sponsoring agencies, sponsors, advertisers, and lessors of
premises used to conduct the Events (collectively, “Releasees”), WITH RESPECT TO ANY AND
ALL PHYSICAL OR EMOTIONAL INJURY, DISABILITY, DEATH, or loss or damage to person or
property directly or indirectly arising from or related to my child or ward’s involvement or participation in
the Events, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR
OTHERWISE, to the fullest extent permitted by law. However, this agreement does not apply to acts of
gross negligence, willful or wanton conduct, or intentional conduct by the Releasees; and
5. I for myself, my spouse, my child or ward, and on behalf of my/our heirs, assigns, personal
Representatives, executors, administrators and next of kin, HEREBY AGREE NOT TO SUE, MAKE OR
FILE ANY LAWSUITS, CLAIMS, PROCEEDINGS OR ANY OTHER ACTIONS OF ANY KIND
WHATSOEVER against any of the Releasees for bodily injury, property damage, disability or death
sustained during my child or ward’s participation in the Events to the fullest extent permitted under the
law, including allegations or claims of negligence on the part of any of the Releasees; however, this
agreement does not apply to acts of gross negligence, willful or wanton conduct, or intentional conduct by
the Releasees.
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.
Signature_______________________________________________ Age__________ Date__________