2004 NFL FLAG FOOTBALL REGISTRATION FORM by y486F4V

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									                 2009 FALL FLAG FOOTBALL - REGISTRATION FORM
                             (Begins October 24, 2009 Honolulu, HI)
Child’s Name___________________________          Parent/Guardian _________________________
Gender________________________________           Address ________________________________
Address_______________________________           City/St/Zip ______________________________
City/St/Zip _____________________________           Home Phone __________________________
Home Phone ___________________________              Work Phone ___________________________
Birth Date _____________________________            Cell Phone ____________________________
Email _________________________________          (Check best to number to contact 9-5pm)
Height ____________ Weight ___________           Email __________________________________
Emergency Contact _____________________             Recreational League       Advance League
Emergency Contact Phone ________________            Check Here for FLAG START PROGRAM (4 and
                                                 younger 5 year olds only)
Choose Region:    East Honolulu (Hawaii Kai-Kahala)     Honolulu (Kaimuki-Nuuanu)
Windward (Kaneohe-Waimanalo)     Central (Salt Lake/Moanalua, Aiea,Pearl City, Mililani,
Waipahu)    Leeward (Kapolei, Makakilo, Ewa, Waianae)
Youth Jersey Size:
   Youth Small/Medium (under 65lb)                   Youth Large/XL (65-100lb)               Adult Medium/Large (100-160lb)                  Adult XL/XXL (over
160lb)

How did you hear about us?                             School    Road Sign      Friend   Direct Mail
                                                       Returning Player   Flyer     Other: _______________________
Special Buddy or Coach Request ?___________________________________________________

If Coaches are needed, would you be willing to Coach?__________________________________

Please Check Experience Level:  Advanced     Intermediate    Beginner
Will you volunteer?  Head Coach    Assistant Coach      Team Helper
Volunteer Info: Name: __________________________ Volunteer D.O.B.: ____________ Volunteer
S.S. #: ____ - ____ - _____ [Please complete to agree to a criminal background check. We do this for all Coaches only]
Volunteer T-Shirt Size:                     Adult L             Adult XL             Adult XXL                   Adult XXXL
Payment: $135.00 per child (no refunds after deadline, September 28) $155 after September 28
  Visa      MasterCard        Amex       Discover    Money Order      Certified / Personal Check
Credit Card # _________________________________ Exp. Date:________ Security Code:_______
Cardholder’s Name (Print): ________________________________
Signature: _____________________________________________
               * All checks or money orders should be made payable to: i9 Sports Honolulu
    You can also register online at www.i9sports.com , by phone : 394-1100 or fax form to: 394-0550
                      Mail to: i9 Sports Honolulu – POB 26080 Honolulu, HI 96825
             FULL PAYMENT AND WAIVERS MUST BE RECEIVED BY September 28, 2009
Liability/Medical Waiver & Model Release:
I certify that my child(ren) is/are in good health and has my permission to participate in the i9 Sports program. In case of medical emergency, I authorize i9 Sports
personnel to seek medical emergency care for my child. I understand that participation in the program involves certain risks, including but not limited to, serious
injury. I hereby assume all of the risks and hazards incidental to my child’s participation in i9 Sports activities, and I do hereby waive, release and absolve i9 Sports
Corporation, Hawaii Sports Zone LLC DBA i9 Sports Honolulu, owners, directors, playing field providers, instructors, assistants, counselors, volunteers and
participants, from any claim arising out of injury to my child or wrongful death arising as a result of child’s participation in the i9 Sports program. I also agree to
indemnify and hold harmless those listed above for all claims arising out of my child(rens) participation in the program and all related activities. I further understand
and agree that those listed above are not responsible for any injury or property damage arising out of the program, even if caused by their negligence.
I also agree to let i9 Sports use participant’s name and photos and likeness free of charge in any manner for any purpose without compensation to participant or
me. I represent that I am a parent/legal guardian to the child(ren) named above and I agree that the grant and release contained therein binds me and the minor to
all of the terms.

Parent/Legal Guardian _____________________________________                               Date: __________________

								
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