Dayton Youth Football League
Division:
MM (4)
FR (5-6)
SO (7-8)
JR (9-10)
SR (11-12)
Dayton Youth Football League P.O. Box 3188 Dayton, TX 77535
www.leaguelineup.com/dyfltx Email: [email protected]
2017 Registration Form Player Information
Football (FB) $200.00
Sibling (S) $175.00
Cheer (CL) $150.00
$60.00 Fundraising Opt-out
Child's Name (First, MI, Last) Address:
Birthdate (MM/DD/YYYY):
City, State, Zip:
Age: (as of August 1):
Phone:
Grade in Fall: School Attending this year:
Parent / Legal Guardian Information Father/Guardian's Name:
Mother's Name:
Address (if Different)
Address (if different):
Home Phone (if different):
Home Phone (if different):
Work Phone:
Work Phone:
Cell Phone:
Cell Phone:
Email:
Email:
Do you have Personal or Group Insurance?
Yes
Name of Insurance Company:
Employer:
No )
(If yes, then complete)
Name of Insured: Please list all pertinent medical information, physical limitations, problems or special needs: Emergency Contact (other than parents): Phone#:
Relationship:
If your child participated with DYFL last season, what team was he/she on: Other sibling participant(s): Name
Age:
Football:
Cheer:
Other sibling participant(s): Name
Age:
Football:
Cheer:
As a parent, I would like to participate in the following league activities. Please check which activities you would be willing to assist: ____Coach ___Asst. Coach ___Team Parent ___Concession ___Clock ___Scorekeeper ___Field Set-up ___Clean Up ___Chains Liability Waiver: I, the parent/legal guardian of the above child, hereby give permission for him/her to participate in any and all Football/Cheer related activities during the current season. I assume all risks of hazards incidental to such activities. I hereby release, waive, and hold harmless the Dayton Youth Football League & East Texas Youth Football Alliance, it's respective organizers, directors, and coaches from any claims arising out of anty injury or damages incurred during or en route to such an activity. Parent/Legal Guardian Signature:_____________________________________________ Date: _________________________________ Medical Authorization Form: I, the parent/legal guardian of the above child, in the event of my absence do hereby give my permission to Dayton Youth Football League, its agents and directors to authorize any medical attention required when an injury has incurred to my child Parent/Legal Guardian Signature:_____________________________________________ Date: _________________________________ Code of Conduct: By signing, I agree to the attached Code of Conducts on behalf of my child as well as the Code of Conduct as a parent. Parent/Legal Guardian Signature:_____________________________________________ Date: _________________________________ Photo Release Waiver: I, the parent/legal guardian of the above child, do hereby give permission to DYFL, its agents and directors to publish my child's photos (team photo, game photos,etc.) on the DYFL website: www.leaguelineup.com/dyfltx or Facebook page. No Refunds: I understand and accept that no refunds will be given FOR ANY REASON. Any checks returned for Insufficient Funds will be assessed a $35.00 NSF fee. Parent/Legal Guardian Signature:_____________________________________________
Date: _________________________________
MM (4)
FR (5-6)
SO (7-8)
JR (9-10)
SR (11-12)
Dayton Youth Football League P.O. Box 3188 Dayton, TX 77535
www.leaguelineup.com/dyfltx Email: [email protected]
2017 Registration Form Player Information
Football (FB) $200.00
Sibling (S) $175.00
Cheer (CL) $150.00
$60.00 Fundraising Opt-out
Child's Name (First, MI, Last) Address:
Birthdate (MM/DD/YYYY):
City, State, Zip:
Age: (as of August 1):
Phone:
Grade in Fall: School Attending this year:
Parent / Legal Guardian Information Father/Guardian's Name:
Mother's Name:
Address (if Different)
Address (if different):
Home Phone (if different):
Home Phone (if different):
Work Phone:
Work Phone:
Cell Phone:
Cell Phone:
Email:
Email:
Do you have Personal or Group Insurance?
Yes
Name of Insurance Company:
Employer:
No )
(If yes, then complete)
Name of Insured: Please list all pertinent medical information, physical limitations, problems or special needs: Emergency Contact (other than parents): Phone#:
Relationship:
If your child participated with DYFL last season, what team was he/she on: Other sibling participant(s): Name
Age:
Football:
Cheer:
Other sibling participant(s): Name
Age:
Football:
Cheer:
As a parent, I would like to participate in the following league activities. Please check which activities you would be willing to assist: ____Coach ___Asst. Coach ___Team Parent ___Concession ___Clock ___Scorekeeper ___Field Set-up ___Clean Up ___Chains Liability Waiver: I, the parent/legal guardian of the above child, hereby give permission for him/her to participate in any and all Football/Cheer related activities during the current season. I assume all risks of hazards incidental to such activities. I hereby release, waive, and hold harmless the Dayton Youth Football League & East Texas Youth Football Alliance, it's respective organizers, directors, and coaches from any claims arising out of anty injury or damages incurred during or en route to such an activity. Parent/Legal Guardian Signature:_____________________________________________ Date: _________________________________ Medical Authorization Form: I, the parent/legal guardian of the above child, in the event of my absence do hereby give my permission to Dayton Youth Football League, its agents and directors to authorize any medical attention required when an injury has incurred to my child Parent/Legal Guardian Signature:_____________________________________________ Date: _________________________________ Code of Conduct: By signing, I agree to the attached Code of Conducts on behalf of my child as well as the Code of Conduct as a parent. Parent/Legal Guardian Signature:_____________________________________________ Date: _________________________________ Photo Release Waiver: I, the parent/legal guardian of the above child, do hereby give permission to DYFL, its agents and directors to publish my child's photos (team photo, game photos,etc.) on the DYFL website: www.leaguelineup.com/dyfltx or Facebook page. No Refunds: I understand and accept that no refunds will be given FOR ANY REASON. Any checks returned for Insufficient Funds will be assessed a $35.00 NSF fee. Parent/Legal Guardian Signature:_____________________________________________
Date: _________________________________
