2009 Football Registration Form

Portland Youth Football League

2009 Football Registration Form

Football Team: _____6/7/8 _____9/10 _____11/12 Team last played for:_______________________________

Child’s Name:__________________________________________________________

Address:________________________________ City, State:_________________________ Zip:________________

Date of Birth:__________________________________ Age prior to Aug. 1st:___________________________

Parent/Guardian Name:_______________________________________ Home Phone # ______________________

Cell Phone #:________________________________ Email address:______________________________________

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

Name: ____________________________________________________ Team:______________________________

Uniform Information - please circle appropriate sizes:

Jersey size: Youth - Small Medium Large Xlarge

Adult - Small Medium Large Xlarge XXlarge XXXlarge

Pants size: Youth - XSmall Small Medium Large Xlarge XXlarge

Adult - Small Medium Large Xlarge

Please understand that you are responsible for sizing your child and that even if a Coach or other league official helps to size your child, it is still your responsibility to make sure that the correct sizes are selected. If we have to re-order a jersey, you will be required to pay for it. _________ (please initial)

Jersey number: 1^st choice:_________________ 2^nd choice:_________________ 3^rd choice:__________________

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.

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

I agree to furnish a notarized copy of my child’s birth certificate before the first practice.

I acknowledge that I must provide my child with a helmet with pads and facemask, shoulder pads, practice pants with pads and a practice jersey.

Fees - $75.00 plus City Park Maintenance Fee of $5.00 Total of $80.00 - Payable at registration and 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.

Player Evaluations

I understand that PYFL has two teams per age group and that football players will be evaluated. I understand that the Coaches for the Purple Teams and White Teams will then draft players based on those evaluations. I understand that if my child can not attend the evaluations that his/her name will be placed in a blind draw and then the coach that draws his/her name will be the team that he/she will be on. All children will be placed on a team. PYFL will not accept requests for a specific coach/team. Siblings will be placed on the same team color for traveling purposes, unless otherwise requested. A player stays on the same team until they age out of that team, then the player must go back into the draft when they move up into another age group.

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 Player.

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, list 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, football carries a risk of potential injury. No matter how careful the player 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 football player agree:

I will not force my child to participate in sports and will remember that children participate to have fun and that the game 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 of the game 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 or losing a game.

I will respect the officials and their authority during games and will never question, discuss, or confront coaches at the game field, and will take the time to speak to a Commissioner 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:____________________________________________________________________________________