Waiver Form
Mid-Florida Pop Warner Youth Football NOTIFICATION OF PLAYER WAIVER REQUEST – EXTENUATING CIRCUMSTANCES WAIVER This is hereby written notification of player/cheerleader request for an extenuating or extraordinary circumstances waiver in 2014 season. accordance with Mid-Florida Pop Warner Youth Football Conference rules for the
I,
the parent or legal guardian of PARENT / LEGAL GUARDIAN
PARTICIPANT’S NAME
am requesting an extenuating circumstances waiver as an eligible player/cheerleader to ASSOCIATION
I fully understand that the information provided for this request will be kept in the strictest confidence. If granted this waiver is applicable for the above referenced association only and will remain in effect as long as determined by the Mid-Florida Executive Board, and must be resubmitted and reviewed each year for approval.
PARENT / LEGAL GUARDIAN SIGNATURE
DATE
I have provided the parent/legal guardian with our registration and Mid Florida waiver policy, informed them of their rights under this policy. I have explained to the parent/legal guardian that this type of waiver is not automatic and will be weighed on the merit of the information provided.
RELEASING COMMISSIONER SIGNATURE
DATE
GAINING COMMISSIONER SIGNATURE
DATE
Mid Florida Executive Board has the sole jurisdiction for the approval or disapproval of this waiver. Your signature is to verify the decision made by the Executive board.
APPROVED
DENIED
MID-FLORIDA POP WARNER STAMP
MFPW SIGNATURE
DATE
The association gaining the participant under this waiver will be responsible for maintaining a copy of the waiver and roster for each season of play. NOTE: this waiver must be resubmitted each year. Original with signatures to be filed with Mid Florida Pop Warner Copy to: Association, Parent Copy of waiver will be attached to official team roster and coach’s roster in team book Page 1 of 2
Mid-Florida Pop Warner Youth Football NOTIFICATION OF PLAYER WAIVER REQUEST – EXTENUATING CIRCUMSTANCES WAIVER Please provide all information and supporting documents relevant to the extenuating and extraordinary circumstances for which this waiver is requested. The circumstances must be of such significance that an undo hardship must be proven. These type waivers will only be granted on a very limited basis. It will be the burden of the requestor to justify any reason for this type waiver.
Page 2 of 2
Instructions for filling out form 1. The Commissioner will provide a Request for Waiver Form and Rules on waivers to requesting parent/legal guardian. 2. The Commissioner will assist parent in filling out form. 3. Commissioner will inform parent/legal guardian about Hardship waiver rights and responsibilities. 4. Parent/legal guardian will sign and date as an acknowledgement of responsibilities and provide information on page 2 as to reason for request. 5. The commissioner will sign, date request and forward the request with any justification to the Mid Florida Pop Warner Executive Board for approval via their Team Management representative. 6. Mid Florida will review and approve/reject and return to commissioner. 7. The Commissioner will provide a copy of the approved/rejected waiver to parent. 8. A copy of the waiver will be attached to the official team rosters if approved.
I,
the parent or legal guardian of PARENT / LEGAL GUARDIAN
PARTICIPANT’S NAME
am requesting an extenuating circumstances waiver as an eligible player/cheerleader to ASSOCIATION
I fully understand that the information provided for this request will be kept in the strictest confidence. If granted this waiver is applicable for the above referenced association only and will remain in effect as long as determined by the Mid-Florida Executive Board, and must be resubmitted and reviewed each year for approval.
PARENT / LEGAL GUARDIAN SIGNATURE
DATE
I have provided the parent/legal guardian with our registration and Mid Florida waiver policy, informed them of their rights under this policy. I have explained to the parent/legal guardian that this type of waiver is not automatic and will be weighed on the merit of the information provided.
RELEASING COMMISSIONER SIGNATURE
DATE
GAINING COMMISSIONER SIGNATURE
DATE
Mid Florida Executive Board has the sole jurisdiction for the approval or disapproval of this waiver. Your signature is to verify the decision made by the Executive board.
APPROVED
DENIED
MID-FLORIDA POP WARNER STAMP
MFPW SIGNATURE
DATE
The association gaining the participant under this waiver will be responsible for maintaining a copy of the waiver and roster for each season of play. NOTE: this waiver must be resubmitted each year. Original with signatures to be filed with Mid Florida Pop Warner Copy to: Association, Parent Copy of waiver will be attached to official team roster and coach’s roster in team book Page 1 of 2
Mid-Florida Pop Warner Youth Football NOTIFICATION OF PLAYER WAIVER REQUEST – EXTENUATING CIRCUMSTANCES WAIVER Please provide all information and supporting documents relevant to the extenuating and extraordinary circumstances for which this waiver is requested. The circumstances must be of such significance that an undo hardship must be proven. These type waivers will only be granted on a very limited basis. It will be the burden of the requestor to justify any reason for this type waiver.
Page 2 of 2
Instructions for filling out form 1. The Commissioner will provide a Request for Waiver Form and Rules on waivers to requesting parent/legal guardian. 2. The Commissioner will assist parent in filling out form. 3. Commissioner will inform parent/legal guardian about Hardship waiver rights and responsibilities. 4. Parent/legal guardian will sign and date as an acknowledgement of responsibilities and provide information on page 2 as to reason for request. 5. The commissioner will sign, date request and forward the request with any justification to the Mid Florida Pop Warner Executive Board for approval via their Team Management representative. 6. Mid Florida will review and approve/reject and return to commissioner. 7. The Commissioner will provide a copy of the approved/rejected waiver to parent. 8. A copy of the waiver will be attached to the official team rosters if approved.
