LIABILITY FORM Cheerleading ...
Please visit our website: www.waynepeewee.org or call 237-0712
W.P.W.F.A EARLY REGISTRATION/LIABILITY FORM Cheerleading $175.00 Early = $125.00
Football Players $175.00 Early = $125.00
Early Registration Is Good Through July 1 st, 2017 FEES PAID: YES
AMOUNT:
CASH
CHECK #
Pay Pal
Registered by (initials):______ Square
Birth Certificate Must Have a Copy
PARTICIPANT'S FIRST NAME
LAST NAME
ADDRESS
CITY
ZIP:
GRADE ENTERING: ______ D.O.B.: m/_____ d/ ____y/________ AGE ON SEPT 1st _______
TELEPHONE #
[Current year]
Wayne Pee Wee Football will be holding a MANDATORY fund raiser. By signing this form you agree to participate. PARENT(S)/GUARDIAN(S) NAME(S): Please PRINT Legibly
Liability/Medical Waiver I, the parent and/or guardian of above named player/cheerleader recognize that football is a contact sport and physical injury is possible while participating in an activity of this nature. I, the parent/guardian, hereby release, and/or discharge the Wayne Pee Wee Football Association, Association Board Members, Referees, Coaches, all employees and volunteers, including the owners of the facilities utilized for this program, from any indemnification from any claim by or on the behalf of the registrant as the result of the registrant's participation in the program, including transportation to or from the same. I, the parent/guardian authorize the emergency treatment in the event the above named child becomes ill or injured while Participating in any Wayne Pee Wee Football Association functions, if parents/guardians cannot be reached. In the event reasonable attempts to contact me at
or (Phone #) (Phone #) If you are not successful, I hereby consent for the administration of any treatment deemed necessary by 2 licensed physicians and/or dentists, for the care of my child. Please list any vital information concerning your child (allergies, medications etc.) Parent's/Guardian's Signature:
m/
d/
y
Parents Cell Phone: __________________________ Parents E-Mail Address: __________________________________________ Wayne Pee Wee Football will be holding a MANDATORY fund raiser. By signing this form you agree to participate or BUYOUT is $125.00 ========================================================================================= Below to be filled out by a Wayne Pee Wee Football staff member.
Player / Cheerleader:
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
CIRCLE ONE
Are you a returner? Yes
No
Siblings: ________________________________________________________________________________________________ Weight: Cheer Info *Shirt Size:
REV 01/2017
Taken By (initials) __________ Date ________
*Pant Size:
*Bloomer Size: *Sock Size: Parents Initials: *Please note that the sizes you indicate will be the size ordered for you.
Date:
W.P.W.F.A EARLY REGISTRATION/LIABILITY FORM Cheerleading $175.00 Early = $125.00
Football Players $175.00 Early = $125.00
Early Registration Is Good Through July 1 st, 2017 FEES PAID: YES
AMOUNT:
CASH
CHECK #
Pay Pal
Registered by (initials):______ Square
Birth Certificate Must Have a Copy
PARTICIPANT'S FIRST NAME
LAST NAME
ADDRESS
CITY
ZIP:
GRADE ENTERING: ______ D.O.B.: m/_____ d/ ____y/________ AGE ON SEPT 1st _______
TELEPHONE #
[Current year]
Wayne Pee Wee Football will be holding a MANDATORY fund raiser. By signing this form you agree to participate. PARENT(S)/GUARDIAN(S) NAME(S): Please PRINT Legibly
Liability/Medical Waiver I, the parent and/or guardian of above named player/cheerleader recognize that football is a contact sport and physical injury is possible while participating in an activity of this nature. I, the parent/guardian, hereby release, and/or discharge the Wayne Pee Wee Football Association, Association Board Members, Referees, Coaches, all employees and volunteers, including the owners of the facilities utilized for this program, from any indemnification from any claim by or on the behalf of the registrant as the result of the registrant's participation in the program, including transportation to or from the same. I, the parent/guardian authorize the emergency treatment in the event the above named child becomes ill or injured while Participating in any Wayne Pee Wee Football Association functions, if parents/guardians cannot be reached. In the event reasonable attempts to contact me at
or (Phone #) (Phone #) If you are not successful, I hereby consent for the administration of any treatment deemed necessary by 2 licensed physicians and/or dentists, for the care of my child. Please list any vital information concerning your child (allergies, medications etc.) Parent's/Guardian's Signature:
m/
d/
y
Parents Cell Phone: __________________________ Parents E-Mail Address: __________________________________________ Wayne Pee Wee Football will be holding a MANDATORY fund raiser. By signing this form you agree to participate or BUYOUT is $125.00 ========================================================================================= Below to be filled out by a Wayne Pee Wee Football staff member.
Player / Cheerleader:
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
CIRCLE ONE
Are you a returner? Yes
No
Siblings: ________________________________________________________________________________________________ Weight: Cheer Info *Shirt Size:
REV 01/2017
Taken By (initials) __________ Date ________
*Pant Size:
*Bloomer Size: *Sock Size: Parents Initials: *Please note that the sizes you indicate will be the size ordered for you.
Date:
