DYFA 2017 Football/Cheer Registration
DYFA 2017 Football/Cheer Registration (WESTERN SUBURBAN JUNIOR FOOTBALL LEAGUE) Please use a separate form for each child, fill in all fields completely, and print clearly. Child’s Last Name:
First:
Weight
Address Street:
City
Phone:
Zip:
Parent/Guardian Email:
Date of Birth:
Age as of 8/31/2017:
Team: ____ Thunderbirds ____ Tractors ____ Pioneers
Grade this fall: ____ School: Status: ____ Returning player/cheerleader ____ New player/cheerleader
Squad
Football
Max Weight
Cheer
Jr. Freshman Freshman Junior Varsity Varsity
7-8 years old 9-10 years old 11-12 years old 13-14 years old
110 lbs. 125 lbs. 145 lbs. 175 lbs.
6-7 years old/grades 1-2 8-10 years old/grades 3-4 9-12 years old/grades 5-6 11-14 years old/grades 7-8
Football*
Cheer*
Deposit
$150 $150 $150 $150
$50-100 $50-100 $50-100 $50-100
$100 $100 $100 $100
Please note: (1) A player’s weight is with full uniform (jersey, pants, knee and thigh pads, girdle, cup, and socks). Shoes, shoulder pads and helmets are not required when determining a player’s weight. (2) Participants will be placed on a squad based upon their age, weight and the availability of roster spots. (3) Children who turn 15 after August 31 and before the completion of the season are not eligible to participate. (4) All participants are required to purchase $100 worth of raffle tickets for the annual fund-raising raffle. * Fees are franchise dependent. Tractors/Thunderbirds/Pioneers have different fee structures. Please see your respective franchise registrar about your applicable fees.
If your child is a new participant, completion of the registration process requires submission of (1) this completed registration form, (2) a $150 registration fee, (3) a $100 raffle ticket fee, (4) a $100 security deposit, (5) a certified copy of your child’s birth certificate, (6) proof of address (a copy of your driver’s license), (7) a signed copy of the concussion awareness form (available www.DYFA.org), and (8) proof that your child has undergone a physical exam and has been cleared to participate. If your child is a returning participant, completion of the registration process requires submission of (1) this completed registration form, (2) a $150 registration fee, (3) a $100 raffle ticket fee, (4) a $100 security deposit, if previously forfeited and (5) proof that your child has undergone a physical exam and has been cleared to participate. As the parent/legal guardian, I hereby give my approval for my child’s participation in any and all of the Dearborn Youth Football Association’s activities during the 2017 season. I assume all risk and hazards incidental to such participation, including transportation to and from the activities; and I do hereby waive, release, indemnify, and agree to hold harmless the local team, the DYFA, the organizers, sponsors, supervisors, participants, and person transporting my child to or from activities from any claim arising out of any injury to my child, except to the extent covered by accident or liability insurance. I hereby certify that both the birth certificate or other proof of age used in the registration of my child and the proof of address provided are true and correct. I understand that should either prove to be otherwise, my child’s eligibility and all fees remitted may be subject to forfeiture. In the event of an injury to my child, I hereby grant consent to the attending medical technician/physician to render whatever emergency medical care he/she has deemed necessary.
Parent/Guardian (Print Name):
______
Parent/Guardian Signature:
______
EMERGENCY CONTACTS (Parents, Legal Guardians, Relatives, Close Friends): Name:
Name:
Relationship:
Relationship:
Telephone:
Telephone: Registration materials may be submitted to DYFA, PO BOX 1995, Dearborn, MI, 48121-1995
First:
Weight
Address Street:
City
Phone:
Zip:
Parent/Guardian Email:
Date of Birth:
Age as of 8/31/2017:
Team: ____ Thunderbirds ____ Tractors ____ Pioneers
Grade this fall: ____ School: Status: ____ Returning player/cheerleader ____ New player/cheerleader
Squad
Football
Max Weight
Cheer
Jr. Freshman Freshman Junior Varsity Varsity
7-8 years old 9-10 years old 11-12 years old 13-14 years old
110 lbs. 125 lbs. 145 lbs. 175 lbs.
6-7 years old/grades 1-2 8-10 years old/grades 3-4 9-12 years old/grades 5-6 11-14 years old/grades 7-8
Football*
Cheer*
Deposit
$150 $150 $150 $150
$50-100 $50-100 $50-100 $50-100
$100 $100 $100 $100
Please note: (1) A player’s weight is with full uniform (jersey, pants, knee and thigh pads, girdle, cup, and socks). Shoes, shoulder pads and helmets are not required when determining a player’s weight. (2) Participants will be placed on a squad based upon their age, weight and the availability of roster spots. (3) Children who turn 15 after August 31 and before the completion of the season are not eligible to participate. (4) All participants are required to purchase $100 worth of raffle tickets for the annual fund-raising raffle. * Fees are franchise dependent. Tractors/Thunderbirds/Pioneers have different fee structures. Please see your respective franchise registrar about your applicable fees.
If your child is a new participant, completion of the registration process requires submission of (1) this completed registration form, (2) a $150 registration fee, (3) a $100 raffle ticket fee, (4) a $100 security deposit, (5) a certified copy of your child’s birth certificate, (6) proof of address (a copy of your driver’s license), (7) a signed copy of the concussion awareness form (available www.DYFA.org), and (8) proof that your child has undergone a physical exam and has been cleared to participate. If your child is a returning participant, completion of the registration process requires submission of (1) this completed registration form, (2) a $150 registration fee, (3) a $100 raffle ticket fee, (4) a $100 security deposit, if previously forfeited and (5) proof that your child has undergone a physical exam and has been cleared to participate. As the parent/legal guardian, I hereby give my approval for my child’s participation in any and all of the Dearborn Youth Football Association’s activities during the 2017 season. I assume all risk and hazards incidental to such participation, including transportation to and from the activities; and I do hereby waive, release, indemnify, and agree to hold harmless the local team, the DYFA, the organizers, sponsors, supervisors, participants, and person transporting my child to or from activities from any claim arising out of any injury to my child, except to the extent covered by accident or liability insurance. I hereby certify that both the birth certificate or other proof of age used in the registration of my child and the proof of address provided are true and correct. I understand that should either prove to be otherwise, my child’s eligibility and all fees remitted may be subject to forfeiture. In the event of an injury to my child, I hereby grant consent to the attending medical technician/physician to render whatever emergency medical care he/she has deemed necessary.
Parent/Guardian (Print Name):
______
Parent/Guardian Signature:
______
EMERGENCY CONTACTS (Parents, Legal Guardians, Relatives, Close Friends): Name:
Name:
Relationship:
Relationship:
Telephone:
Telephone: Registration materials may be submitted to DYFA, PO BOX 1995, Dearborn, MI, 48121-1995
