register - Phoenixville Phuture Phantoms Football

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: ______________