Phoenixville Phuture Phantom Football Participant Registration Form (Please Select One) Flag Football Tackle Football Cheerleading Participant Name First:_____________________________ Last:_______________________ Personal Information Date of Birth: ___/___/___ Gender Age:____ Male Female School:________________ Graded (Sept. 2015)_______ Parent/Guardian Information: Mom:_________________________ Dad:__________________________ Address:_______________________ Address:_______________________ ______________________________ ______________________________ Home Phone:___________________ Home Phone:___________________ Cell Phone:_____________________ Cell Phone:_____________________ Email Address:__________________ Email Address:__________________ Registration Fees Flag Football - $60 per child Cheerleading - $95 Tackle Football - $150 There is a $25.00 discount per each child Registration fee are non-refundable NFS checks will be assessed a $35 dollar service charge Early Registration Discount until 5/31/15 Flag Football - $45 Cheerleading - $80 Tackle Football - $125 Volunteer Service Per Family In order to bring your child the best experience we ask for your support and involvement. Each family is required to commit to 4 hours of Volunteer participation. Families can elect out of volunteer participation by making a monetary donation in the amount of $50 payable to Phoenixville Phuture Phantoms at the time of registration. Uniform Agreement Uniform care and return will be the responsibility of the parent or guardian of the player. All uniforms must be returned in the same condition they are received with the exception of normal wear. A monetary fee could be charged for uniforms that are lost, severely damaged or returned in unsatisfactory condition. Medical Release: I, ________________________, parent/guardian of _______________________, do hereby give permission for him/her to be treated for any medical deemed necessary by the coach, physician, or hospital. He/She is allergic to the following medicine, insects, food, etc.:_________________________________ Parent/Guardian Release (Please Read) In consideration of your accepting me or my child’s entry, I hereby, for myself, my child, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I or my child may have against Phoenixville Phuture Phantoms Football, and/or its representatives, successors, and volunteers assisting in league activities, for any and all injuries suffered by myself or my child on any activity sponsored by these groups. I do assume all risk and hazards incidental to such participation; and do hereby waive release, absolve, indemnify, and agree to hold harmless the Phoenixville Phuture Football League, the organization, sponsors, supervisors, and participants for any claim arising out of an injury to my child whether the result of negligence or from any other cause. Participant must recognize that all activities of a physical nature involve some risk and by registering for an activity for this nature there is an assumption of risk by the participant. The Phoenixville Phuture Football League is dedicated to providing safe facilities and equipment for all participants. Every effort is made to insure the safety of the participant and to provide them with first-class recreational activity. I understand that the PPF insurance is supplemental to my existing insurance and in no means is designated to cover any and all medical expenses in case of accident or illness. In the event of a serious accident or illness normally the PPFL (1) would contact the local Fire Department Paramedics and perform first aid and when necessary recommend transportation to a hospital; (2) reach the parent or guardian as soon as the situation allows. I further certify the birthday for any child is correct as shown on the birth certificate. Parent/Guardian Signature:_____________________________ Official Use Only Age:__________ Grade__________ Yrs. Experience___________ Birth Cert: On File Required // Report Card: On File Required Date:______________ PHUTURE PHANTOM PARENTAL CONSENT FORM EMERGENCY TREATMENT THE FOLLOWING FORM IS TO GIVE PP YOUTH FOOTBALL INFORMATION AND PERMISSION TO TREAT YOUR CHILD IN CASE OF AN EMERGENCY IN THE RARE CASE THAT YOU CANNOT BE REACHED IN A REASONABLE AMOUNT OF TIME. THIS FORM MUST BE COMPLETED BEFORE YOUR CHILD WILL BE PERMITTED TO PRACTICE. THE COACH WILL CARRY THIS FORM TO ALL GAMES, HOME AND AWAY SO THE INFORMAITON WILL BE READILY AVAILABLE. Name: _________________________________ Date of Birth: ______________ (Child’s full name) Address: ______________________________________________________________________ Parents Name(s): _______________________________________________________________ Phone: (home) ________________________ (work/cell):________________________________ IF I CANNOT BE REACHED AT THE ABOVE NUMBERS, PLEASE CONTACT THE FOLLOWING ON MY BEHALF: Name: ______________________________________ Phone: ____________________ Please list relationship to child: (Grandparent, etc.) ____________________________________ I, _________________________________ (Parent, legal Guardian name) give my permission for emergency diagnosis and treatment of my child, _______________________________________(childs name), If such treatment is felt appropriate by the coach or PP Youth Football Personnel. Diagnosis and treatment may be given by the nearest medical or emergency treatment facility. Family Doctor is: ______________________________ Phone: ____________________ PARENT/LEGAL GARDIAN SIGNATURE: _________________________________________ Health Insurance Carrier: _________________________________________________________ Policy Number: ________________________________ Expiration: _______________ PHOTO CONSENT I (parent/guardian name) _____________________________________ Do_____ Do Not______ Give PPYF permission to display pictures of my child/children for both use on their website, social media (including but not limited to Facebook & Twitter) and/or to submit to local news for marketing purposes. I understand all pictures of my child submitted to PPYF become the property of PPYF. I do not hold PPYF responsible for any unauthorized download or distribution of said photos. Childs Name: _________________________ Age: ______________ Parent Signature: _____________________________Date: _______________ TEXTING CONSENT I would like to be added to your text messaging option for organizational updates and news. I understand that standard rates do apply. Cell Phone # ______________________________________________ Parent Signature: _______________________________Date: ______________