DJFL PLAYER REGISTRATION â 2017
DJFL PLAYER REGISTRATION – 2017 Player Registration Fee, Uniform, and Equipment Rentals = (Cash or Check) $ 160.00 Player Registration Fee, Uniform, and Equipment Rentals = (Credit Card) $ 165.00 Includes:
Game Jersey, Game Pants, Game Socks, Helmet Decals, Mouthguard Rental of Helmet and Shoulder Pads
Player Must Provide Practice Jersey, Practice Pants, Cleats PLAYER NAME: _____________________________________________________________________________________ LAST FIRST MIDDLE _____________________________________________________________________________________ ADDRESS DATE OF BIRTH _______________GRADE ATTENDING THIS FALL ________________________ PARENTS/GUARDIANS: FATHERS NAME _____________________________________________________________________ FATHERS PHONE #(H) ________________________________________________________________ FATHERS CELL #(C) __________________________________________________________________ FATHERS EMAIL ____________________________________________________________________ MOTHERS NAME_____________________________________________________________________ MOTHERS PHONE #(H)________________________________________________________________ MOTHERS CELL #(C) _________________________________________________________________ MOTHERS EMAIL ___________________________________________________________________ WHO DOES THE PLAYER LIVE WITH __________________________________________________ EMERGENCY CONTACT: NAME _______________________ PHONE # _______________________ NAME _______________________ PHONE #_______________________ SPECIAL MEDICAL CONDITIONS ______________________________________________________ NUMBER OF YEARS PARTICIPATION_______ TEAM LAST YEAR__________________________ NOTICE: The Danville Junior Football League does NOT carry insurance on the individual participants .Medical insurance will be the responsibility of each participant’s parents. I/We accept responsibility for the condition of any/all equipment and uniforms handed out to my child. I/We agree to turn in all equipment on the designated turn in date or pay a late fee of $25.00. If I choose to provide my child with his/her own equipment I will take full responsibility for the proper fit of that equipment. I give permission for my child to participate in all DJFL activities including the Homecoming Parade and assume all risks and hazards incidental to such participation, including transportation to and from activities. I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the DJFL, the organizers, board members, supervisors, coaches, participants and the persons transporting my child, including Danville School Corporation. I/We understand that football is a full contact sport and certain injuries can arise in the course of the game or related league activities that are beyond the control of the league. I/We understand that by signing this form, we the parents of the above named participant assumes all risk that are inherent to the game of football.
PARENTS/GUARDIANS SIGNATURE ___________________________________________________________ DATE _________________
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DJFL PLAYER REGISTRATION – 2017 PLAYER NAME: _____________________________________________________________________________________________ LAST FIRST MIDDLE
DATE OF BIRTH _________________________GRADE ATTENDING THIS FALL _______________________
PREFERRED JERSEY NUMBER: CHOICE 1:___________ CHOICE 2: ____________ CHOICE 3:___________ _____________________________________________________________________________________________
THIS SECTION IS FOR LEAGUE USE ONLY: CAMP: YES - NO PLAYERS WEIGHT __________ HELMET # _________________ SHOULDER PAD # ___________________
JERSEY SIZE: YOUTH YS – YM - YL - YXL ADULT AS – AM – AL – AXL – A2X – A3X
PANTS SIZE: YOUTH YXXS - YXS – YS - YM – YL – YXL – YH – Y2XL ADULT AS – AM – AL - AXL PAYMENT:
SFAK #: ______ Check #: ______
Amount : $ ________
Credit Card #:_______________________ Expiration Date: ___________ Amount $____________ _____________________________________________________________________________________________
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Game Jersey, Game Pants, Game Socks, Helmet Decals, Mouthguard Rental of Helmet and Shoulder Pads
Player Must Provide Practice Jersey, Practice Pants, Cleats PLAYER NAME: _____________________________________________________________________________________ LAST FIRST MIDDLE _____________________________________________________________________________________ ADDRESS DATE OF BIRTH _______________GRADE ATTENDING THIS FALL ________________________ PARENTS/GUARDIANS: FATHERS NAME _____________________________________________________________________ FATHERS PHONE #(H) ________________________________________________________________ FATHERS CELL #(C) __________________________________________________________________ FATHERS EMAIL ____________________________________________________________________ MOTHERS NAME_____________________________________________________________________ MOTHERS PHONE #(H)________________________________________________________________ MOTHERS CELL #(C) _________________________________________________________________ MOTHERS EMAIL ___________________________________________________________________ WHO DOES THE PLAYER LIVE WITH __________________________________________________ EMERGENCY CONTACT: NAME _______________________ PHONE # _______________________ NAME _______________________ PHONE #_______________________ SPECIAL MEDICAL CONDITIONS ______________________________________________________ NUMBER OF YEARS PARTICIPATION_______ TEAM LAST YEAR__________________________ NOTICE: The Danville Junior Football League does NOT carry insurance on the individual participants .Medical insurance will be the responsibility of each participant’s parents. I/We accept responsibility for the condition of any/all equipment and uniforms handed out to my child. I/We agree to turn in all equipment on the designated turn in date or pay a late fee of $25.00. If I choose to provide my child with his/her own equipment I will take full responsibility for the proper fit of that equipment. I give permission for my child to participate in all DJFL activities including the Homecoming Parade and assume all risks and hazards incidental to such participation, including transportation to and from activities. I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the DJFL, the organizers, board members, supervisors, coaches, participants and the persons transporting my child, including Danville School Corporation. I/We understand that football is a full contact sport and certain injuries can arise in the course of the game or related league activities that are beyond the control of the league. I/We understand that by signing this form, we the parents of the above named participant assumes all risk that are inherent to the game of football.
PARENTS/GUARDIANS SIGNATURE ___________________________________________________________ DATE _________________
1 OF 2
DJFL PLAYER REGISTRATION – 2017 PLAYER NAME: _____________________________________________________________________________________________ LAST FIRST MIDDLE
DATE OF BIRTH _________________________GRADE ATTENDING THIS FALL _______________________
PREFERRED JERSEY NUMBER: CHOICE 1:___________ CHOICE 2: ____________ CHOICE 3:___________ _____________________________________________________________________________________________
THIS SECTION IS FOR LEAGUE USE ONLY: CAMP: YES - NO PLAYERS WEIGHT __________ HELMET # _________________ SHOULDER PAD # ___________________
JERSEY SIZE: YOUTH YS – YM - YL - YXL ADULT AS – AM – AL – AXL – A2X – A3X
PANTS SIZE: YOUTH YXXS - YXS – YS - YM – YL – YXL – YH – Y2XL ADULT AS – AM – AL - AXL PAYMENT:
SFAK #: ______ Check #: ______
Amount : $ ________
Credit Card #:_______________________ Expiration Date: ___________ Amount $____________ _____________________________________________________________________________________________
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