2015 FALL SEASON FOOTBALL and CHEER
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2015 FALL SEASON FOOTBALL and CHEER
Join Black Hills Youth Football and Cheer League TODAY Open to all kids Grades 1st thru 8th for football players and cheerleaders 2015 FALL SEASON FOOTBALL and CHEER On regulation field with announcers, music and cheerleaders Sign up on-line at Http://bhyfl.leag1.com Or for questions contact us at (605) 791-3381 Required Documents COPIES ONLY (DO NOT MAIL -give to team mom) ____Birth Certificate ____Wallet-sized photo ____Participant Code of Conduct ____Parent Code of Conduct ____Medical Clearance from 2015 ____ a 2014 Report card Received Date Stamp 2015 BHYFL Registration Please mail Registration form and fees to: “BHYFL 2015” Tackle football Mitey Mite (1/2nd grade – 3rd grade older/lighter) Cheer Jr Pee (3/4th grade – 5th grade older/lighter) New Registrant: Football $210 PO Box 999 Box Elder, SD 57719 Pee Wee (5/6th grade – 7th grade older/lighter) 605-791-3381 Senior Pee Wee (7/8th grade – 9th grade older/lighter) Returning Player registration $195 $85 special rate for 7th,8th or 9th graders! ALL Cheer $90 Plus uniform which each team/cheerleader gets to keep! WEIGHT AT REGISTRATION (Football) Amt Paid __________ Check # ___________ (All returned checks are assessed a $35.00 fee) All registrants must be paid in full at registration. *Medical clearance must be submitted before practice begins or THE PARTICIPANT CANNOT PRACTICE FOOTBALL OR CHEER. Student Athlete’s (Name must match birth certificate exactly) LAST NAME 2014 Division/Team: Is Parent a coach or team mom? FIRST NAME Siblings and ages in program? PHYSICAL ADDRESS HOME PHONE ( CITY ) BIRTH DATE MIDDLE SCHOOL DISTRICT: *AGE AS OF 11/15/15 ZIP *School Grade as of fall - 2015 REFERRING ORGANIZATION/PERSON: *HIGH SCHOOL DISTRICT CURRENT SCHOOL ATTENDING EMERGENCY CONTACT RELATION FATHER/GUARDIAN Primary NAME ADDRESS (if different) ADDRESS (if different) CITY, ZIP CITY, ZIP PHONE ( ) PHONE ( ) CELL ( ) E-MAIL (mandatory) PLEASE PRINT VERY CLEARLY PHONE (cell ) PHONE (home) MOTHER/GUARDIAN NAME BUS PH ( ) MIDDLE NAME BUS PH ( ) Primary CELL ( ) E-MAIL (mandatory) PLEASE PRINT VERY CLEARLY PARENTAL CONSENT: PLEASE READ AND SIGN: APPLICATION MUST HAVE AT LEAST ONE PARENT/GUARDIAN SIGNATURE I/WE, the Parents/Guardians of the above named candidate for a position on any of the BHYFL Youth Football/Cheer teams, hereby give MY/OUR approval to his/her participation in any and all BHYFL Youth Football/Cheer activities during the current year. I/WE assume all risks and hazards incidental to such participation including transportation to and from such activities, and I/WE do hereby waive release, absolve, indemnify and agree to hold harmless the BHYFL Youth Football League and its Associations, the sponsors, supervisors, participants, employees, volunteers and persons transporting MY/OUR child to and from activities for any claim arising out of injury to MY/OUR child. I/WE and participant agree to abide by the BHYFL Rules of Conduct. I/We give the BHYFL President/Commissioner or his/her designee permission to verify our child’s age if needed by the use of our child’s school records. The BHYFL reserves the right to refuse to accept ANYONE or to remove ANYONE from the program at anytime as the BHYFL sees fit so as to preserve the safety, integrity and character of the BHYFL and its’ participants. All involved with the BHYFL in any capacity must obey the Codes of Conduct as set forth by the BHYFL whether they have received and or signed said code of conduct or not. (it is posted on our website) PARENTAL MEDICAL TREATMENT AUTHORIZATION: In the event of injury to MY/OUR child, I/WE hereby grant authority to present or qualified personnel to render such medical treatment as said personnel deems necessary under the circumstances. PARENT/PARTICIPANT RULES OF CONDUCT: I/WE and MY/OUR child agree to abide by the Rules of Conduct and understand the possible consequences of violating the Rules of Conduct. It IS possible my child may NOT be able to play this season, due to lack of registration in his/her age division. In that case All paid monies will be refunded if approved. ANY Approved refunds will be refunded at the end of the current season. Code of conducts can be found at www.BlackHillsYouthFootball.com EQUIPMENT LIABILITY: Parent/Guardians are responsible for return of all equipment and uniforms, clean and in good condition. You, the Parent/Guardian will be responsible for reimbursement to the league for any cost of lost or excessively damaged equipment or uniforms. *Failure to return all issued equipment could result in criminal prosecution for Failure to Return Rental property. WEB SITE PICTURES: I/WE give permission to have my child’s picture on the BHYFL web site, any association ID card, film, or advertisement literature. Note: If you have any questions, please contact us at 605-791-3381 OR [email protected] I/WE have read the above and agree with and understand the policies set forth above. ALL REGISTRATION FEES ARE NONREFUNDABLE X _________________________________________________________________ X__________________________________________________________________ (Father/Legal Guardian Signature) (Date) (Mother/Legal Guardian Signature) (Date) FOR LEAGUE USE ONLY TEAM ASSIGNMENT: _______________________________ DIVISION: _____________________________ MED RELEASE ______ PHOTO ______ BIRTH CERT. ______