2010 New Player Registration Form

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
2010 Registration Dates:
   6/11/2010, 5-8pm, Groveland Town Hall    or    6/12/2010, 9-NOON, Groveland Town Hall
YOU WILL NOT BE ALLOWED TO REGISTER WITHOUT A VALID BIRTH CERTIFICATE
First Name: Last Name:  
Street: Town: State:   Zip:
Telephone: E-Mail:
Weight: 1st Year With PYF: 2010
D.O.B.: Grade As of September, 2010
Mother's Name: Father's Name:
A & B team players must be 14 or younger as of September 1, 2010
C team players must be 12 or younger as of September 1, 2010
  I hereby indemnify and hold harmless the Pentucket Youth Football League 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. 
I give my child permission to participate in the Pentucket Youth Football League program.
PARENT/GUARDIAN NAME (please print or type)

 PARENT/GUARDIAN SIGNATURE: ___________________________
REGISTRATION FEE: New Players:
Returning Players:
Additional Players (new or returning): 		$250
$225
$125
NO refunds will be made after the start of the season, 8/16/2010
Make checks payable to: PENTUCKET YOUTH FOOTBALL LEAGUE
I understand all equipment including jersey, must be returned at the end of the season. Failure to do so will result in replace cost of $875.
  PARENT/GUARDIAN SIGNATURE: ___________________________

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 League
attending official to act on my behalf in securing and authorizing medical care for my child, in case of a medical emergency.

  PARENT/GUARDIAN SIGNATURE: ___________________________