Pentucket Youth Football |
| 2012 Player Registration Form |
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Registration
Instructions:
- Fill in all fields on this
form, Print using the PRINT button below, sign where
indicated
- On Registration Day bring
a printout of this form, a COPY of the child's birth certificate &
payment in FULL
- Returning players may mail
this form and payment to Pentucket Youth Football, c/o 89 West Main St.,
Merrimack, MA 01860 |
2012 Registration Dates: 6/17/2011, 5-8pm, Groveland Town Hall or 6/18/2011, 9-11am, Groveland Town Hall |
| YOU
WILL NOT BE ALLOWED TO REGISTER WITHOUT A VALID BIRTH CERTIFICATE
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I hereby
indemnify and hold harmless Pentucket Youth Football and its
members from any claims my child or any of their heirs, assigns or representatives
may have for injuries sustained during football practice and/or games.
I am aware that football is a contact sport and, as such, injuries are
likely to occur.
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| I
give my child
permission to participate in the Pentucket Youth Football program. |
| PARENT/GUARDIAN NAME (please
print or type) |
PARENT/GUARDIAN SIGNATURE: ___________________________ |
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| REGISTRATION
FEE: $250, additional family members $125 |
New in 2011: Players will be receiving new practice jerseys,
pants, girdles with pads, T-Shirts and mouth guards all of which they may keep.
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NO
refunds will be made after the start of the season, 8/15/2011
Make checks payable to: PENTUCKET YOUTH
FOOTBALL |
| I understand
that the helmet, shoulder pads, game jerseys and game pants must be returned at the
end of the season. Failure to do so will result in an assessment to the parent for
the replacement cost. |
| PARENT/GUARDIAN
SIGNATURE: ___________________________ |
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| As
a parent or guardian of this child, I hereby give approval to their
participation in this league. I agree to furnish a birth certificate
and proof of primary insurance coverage for this child upon request
of the league.
Also, in the absence of the parent/guardian
I hereby authorize the Pentucket Youth Football
attending official to act on my behalf in securing and authorizing medical
care for my child, in case of a medical emergency.
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PARENT/GUARDIAN
SIGNATURE: ___________________________ |
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