2016 Westosha Falcon Youth Football Registration Form
2016 Westosha Falcon Youth Football Registration Form Completion of this form & payment of fees will register your player(s) for Westosha Falcon Youth Football (WFYF) and secure placement on a WFYF team for the fall 2016 season. Please complete form & return with payment to: CHS Athletic Director, 24617-75th Street, PO Box 38, Salem, WI 53168
F
PLAYER INFORMATION: Returning WFYF player First-time WFYF player Last name: ________________________________________________ First name: _______________________________________ Address: __________________________________________ City: ___________________________ State: ______ Zip: ___________ Date of birth: ________________ Age of August 1, 2016: _______ School: ________________________ Grade (Fall 2016): ______ PARENT/GUARDIAN INFORMATION:
WHERE DID YOU HEAR ABOUT WFYF REGISTRATION THIS YEAR?
Name: ____________________________________ Relationship: __________________
Banner/posted flyer Social media Coach Mengel/CHS westofthei.com Community Report Word of mouth Kenosha News Other _________ Grade school or sports event
Email: ____________________________________ Phone: _______________________ Name: ____________________________________ Relationship: __________________ Email: ____________________________________ Phone: _______________________ Emergency contact (in event parent(s)/guardian(s) listed above cannot be reached):
Name: ___________________________________________________________ Phone: ____________________________________ MEDICAL INFORMATION: Medical conditions and/or restrictions: ____________________________________ Allergies: _______________________________ Medications: __________________________________________________ Medications needed at practices/games:
YES
NO
Additional medical details: _____________________________________________________________________________________ SIBLING INFORMATION: Please list full name & grade (fall 2016) of sibling(s) registering for WFYF 2016 season. Sibling 1:__________________________________ Grade: ______
Sibling 3: _____________________________ Grade: ______
Sibling 2:__________________________________ Grade: ______
Sibling 4: _____________________________ Grade: ______
VOLUNTEER AVAILABILITY: Westosha Falcon Youth Football is in need of volunteers. Please mark position(s) that interest you: Head coach
Assistant coach
Team parent
Fundraising assistant
SEASON FEES: Due at registration. Early bird and sibling discounts available.
Concessions helper
$175--payment by April 1, 2016 $200—payment after April 1, 2016 $175—each additional sibling TOTAL FEES DUE: $ ________________
Fees include purchase of game jersey (to be kept by player after season) and use of helmet, shoulder pads, and game pants for 2016 season.
Please make checks payable to: Westosha Falcon Youth Football PARENT/GUARDIAN SIGNATURE:
I, the undersigned parent or guardian, waive all rights to hold Westosha Falcon Youth Football, LLC, its coaches, officials, and Board of Directors responsible for any injury to my child during the 2016 football season. I understand that refunds will not be given after August 15th.
Signature: ___________________________________________________________________ Date: __________________________ Please refrain from using my child’s photo for WFYF promotional purposes.
Westosha Falcon Youth Football Official Use Only League:
1/2
3/4
5th
6th
7th
8th
Helmet:
XXS
XS
S
M
L
XL
2XL
Jaw pad:
1/2
5/8
3/4
7/8
1
1-1/8
1-1/4
Jersey:
YM
YL
YXL
S
M
L
XL
2XL
3XL
Pant:
YXS
YS
YM
YL
YXL
S
M
L
XL
Height (inches) ___________ 3XL
Weight (lbs.) _____________ Waist (inches) ____________ 2X
3X
40 yd. dash ______________
Westosha Falcon Youth Football Official Use Only Total fees due: _______________ Scholarship: _________________ Amount paid: ________________
Cash: $ _____________________ Check: $ ____________________ Check number: _______________
BIRTH CERTIFICATE VERIFIED FORM RECEIVED BY: _______________________ DATE: ____________________________________
F
PLAYER INFORMATION: Returning WFYF player First-time WFYF player Last name: ________________________________________________ First name: _______________________________________ Address: __________________________________________ City: ___________________________ State: ______ Zip: ___________ Date of birth: ________________ Age of August 1, 2016: _______ School: ________________________ Grade (Fall 2016): ______ PARENT/GUARDIAN INFORMATION:
WHERE DID YOU HEAR ABOUT WFYF REGISTRATION THIS YEAR?
Name: ____________________________________ Relationship: __________________
Banner/posted flyer Social media Coach Mengel/CHS westofthei.com Community Report Word of mouth Kenosha News Other _________ Grade school or sports event
Email: ____________________________________ Phone: _______________________ Name: ____________________________________ Relationship: __________________ Email: ____________________________________ Phone: _______________________ Emergency contact (in event parent(s)/guardian(s) listed above cannot be reached):
Name: ___________________________________________________________ Phone: ____________________________________ MEDICAL INFORMATION: Medical conditions and/or restrictions: ____________________________________ Allergies: _______________________________ Medications: __________________________________________________ Medications needed at practices/games:
YES
NO
Additional medical details: _____________________________________________________________________________________ SIBLING INFORMATION: Please list full name & grade (fall 2016) of sibling(s) registering for WFYF 2016 season. Sibling 1:__________________________________ Grade: ______
Sibling 3: _____________________________ Grade: ______
Sibling 2:__________________________________ Grade: ______
Sibling 4: _____________________________ Grade: ______
VOLUNTEER AVAILABILITY: Westosha Falcon Youth Football is in need of volunteers. Please mark position(s) that interest you: Head coach
Assistant coach
Team parent
Fundraising assistant
SEASON FEES: Due at registration. Early bird and sibling discounts available.
Concessions helper
$175--payment by April 1, 2016 $200—payment after April 1, 2016 $175—each additional sibling TOTAL FEES DUE: $ ________________
Fees include purchase of game jersey (to be kept by player after season) and use of helmet, shoulder pads, and game pants for 2016 season.
Please make checks payable to: Westosha Falcon Youth Football PARENT/GUARDIAN SIGNATURE:
I, the undersigned parent or guardian, waive all rights to hold Westosha Falcon Youth Football, LLC, its coaches, officials, and Board of Directors responsible for any injury to my child during the 2016 football season. I understand that refunds will not be given after August 15th.
Signature: ___________________________________________________________________ Date: __________________________ Please refrain from using my child’s photo for WFYF promotional purposes.
Westosha Falcon Youth Football Official Use Only League:
1/2
3/4
5th
6th
7th
8th
Helmet:
XXS
XS
S
M
L
XL
2XL
Jaw pad:
1/2
5/8
3/4
7/8
1
1-1/8
1-1/4
Jersey:
YM
YL
YXL
S
M
L
XL
2XL
3XL
Pant:
YXS
YS
YM
YL
YXL
S
M
L
XL
Height (inches) ___________ 3XL
Weight (lbs.) _____________ Waist (inches) ____________ 2X
3X
40 yd. dash ______________
Westosha Falcon Youth Football Official Use Only Total fees due: _______________ Scholarship: _________________ Amount paid: ________________
Cash: $ _____________________ Check: $ ____________________ Check number: _______________
BIRTH CERTIFICATE VERIFIED FORM RECEIVED BY: _______________________ DATE: ____________________________________
