2009 Cheer Registration Form

Portland Youth Football League

2009 Cheer Registration Form

Cheer Team: _____6/7/8 _____9/10 _____11/12 Team last cheered for:_______________

Child’s Name:_________________________________________________________________

Address:___________________________ City, State:_______________________ Zip:______

Date of Birth:__________________________________ Age prior to Aug. 1, 2007:__________

Parent/Guardian Name:___________________________________Home Phone # :_________

Cell Phone #:_____________________________ Email address:________________________

Please list any sibling’s that are playing or cheering for PYFL:

Name: ____________________________________ Team:______________________________

Name:____________________________________ Team:______________________________

EACH CHILD WILL PAY A PORTLAND CITY PARK MAINTENANCE FEE OF $5.00. THIS $5.00 GOES DIRECTLY TO THE CITY OF PORTLAND PARKS DEPARTMENT.

Uniform Information - please circle appropriate sizes:

Youth Sizes:

TOP:

Extra small Small Medium Large

SKIRT:

Extra small Small Medium Large

Adult Sizes:

TOP:

Small Medium Large

SKIRT:

Small Medium Large

Bloomers:

Extra small Small Medium Large

League Use

Cash:____________ Check #:____________ Amount:____________ Balance:____________ Rec’d by:____________ Birth Cert:____________

Multi Child Discount and other payment information:___________________________________________________________________________

Agreements/Acknowledgements

I grant permission for my child to be included in pictures taken of activities for the news media and/or for use in Portland Youth Football publications or web site. _____ Yes _____ No

Registration Fee and Uniform Fee - Registration Fee is $40.00, Uniform Fee is $90.00 and Park Maintenance Fee is $5.00 for total of $135.00 - Due at registration.

Multi-child discount - 1^{st child pays full registration fees, each additional child from same household will receive $5.00 discount.}

I understand that all fees are non-refundable.

Emergency Medical and Surgical Treatment

I hereby give my consent in the event of a medical emergency, when I, or my emergency contact, cannot be reached, for the coach or person in charge to obtain whatever treatment may be deemed necessary for the above named child. The authorization includes my consent for the above child to receive emergency treatment by a physician in any hospital. I understand that any expense incurred for proper medical treatment will be the responsibility of the child’s parents or guardians.

Notify in case of Emergency:__________________________________ Phone #: ____________

Any known allergies, conditions or reactions to medications:______________________________

_____________________________________________________________________________

Any medical conditions coaches, etc. should know about: _______________________________

_____________________________________________________________________________

Currently taking medications: yes or no If yes, what medications:________________________

_____________________________________________________________________________

Does child have: Health Insurance: yes or no Dental Insurance: yes or no

Hospital of Choice: ______________________________________________________________

Physician’s Name & Phone #:_____________________________________________________

Volunteer Agreement

Concession/Merchandise Stand & Gate: The concession stand, merchandise and gate are operated and maintained by PYFL. We rely on parents to help us operate the stand and gate during the season. With your help, we can keep fees down and have great food, snacks and drinks available during your child's games. Each team is assigned to work shifts. We ask that each family work at least one shift per child signed up to play in the league. The shifts are 2 1/2 hours long. The stand will be opened and closed by our league and parents will sell goods during the shift. Children above the age of 16 are allowed in to help, although anyone operating the cash register or grill must be at least 18 years old.

Release of Liability

I understand by the very nature of the activity, cheerleading carries a risk of potential injury. No matter how careful the child and coach are, I understand that there is a risk of injury. The risk includes minor injuries such as broken bones, dislocations and muscle pulls. The risk also includes catastrophic injuries such as permanent paralysis or even death from landing or falling on the back, head or neck. The undersigned agrees, individually and on behalf of the child, that the child, by and through the undersigned or any other person, will not institute or commence any action at law or equity for any damage of any kind that may be sustained by the child as a result of participation in the program. The undersigned further agrees, individually and on behalf of the child, to release, indemnify and hold harmless the organization, its successors, members, directors, officers, coaches, sponsors and volunteers from any claims, demands or actions at law or equity that may subsequently be brought by or on behalf of the child to recover for injuries

or damages, including claims for contribution or indemnification made by third parties, arising out of injuries resulting from participation in the program.

Parent Code of Conduct

I, as a parent or legal guardian of a PYFL cheerleader agree:

I will not force my child to participate and will remember that children participate to have fun and that this is for youth, not adults.

I will inform the coach of any physical disability or ailment that may affect the safety of my child or the safety of others.

I will learn and abide by the rules and the policies of the league.

I will not engage in any kind of unsportsmanship like conduct with any official, coach, player, cheerleader or parent such as booing and taunting, refusing to shake hands; or using profane language or gestures.

I will not encourage any behaviors or practices that would endanger the health and well-being of the children.

I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence.

I will never ridicule or yell at my child or other participants for making a mistake.

I will respect the officials and their authority during games and will never question, discuss, or confront coaches at the game, and will take the time to speak to a Commissioner, Cheer Director or Coach at an agreed upon time and place.

I will demand a sports environment for my child that is free from drugs, tobacco, and alcohol and I will refrain from their use at all sports events.

I will emphasize to my child the importance of maintaining passing grades in school.

I will refrain from coaching my child or other children during games and practices, unless I am one of the official coaches of the team.

I will pick-up after myself and my family/guests at practice as well as the games.

I will make every effort for my child to be on time for games and practice.

I acknowledge that I must stay at practice with my child and that if I cannot be at the practice, that I will arrange for another parent to look after my child.

I also agree that if I fail to abide by the aforementioned rules and guidelines, I will be subject to action that could include, but is not limited to the following:

Verbal warning by Official, Head Coach and/or Commissioner of league

Asked to leave practice and/or game

Parental game suspension

Parental season suspension

I have read and understand the contents of the forgoing documents (pages 1-3) and voluntarily place my signature hereon as evidence of agreement to and acceptance to all of the conditions.

Executed on the ___________________ day of _________________________, 20__________

Parents or Legal Guardian:________________________________________________________

Witness:______________________________________________________________________