2011_Cheerleading_Only_Registration_Form

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					           Date:_______ Paid:_______ Check#:_______ Initials:_______ Fundraising Option:_______

                          Sanborn Junior Indians Football & Cheerleading Organization
                                          P.O. Bo x 1281 Kingston New Hampshire 03848


             The 2011 Sanborn Youth Football & Cheerleading Season begins in August.

         Cheerleading Only - Children grades 1 to 8, as of September 1, 2011 are eligible to play.

                                                       WEB SITE
    Sanborn Youth Football & Cheerleading organization web site: www.sanbornjrindians.com OR www.sanbornyouthfootball.com
                                     And our email address: info@sanbornyouthfootball.com
         You can find: Signup forms, sport schedules, contact names and phone numbers, helpful links and sponsor lists !

                                               REGI STR AT I ON                   FEES
                                            Make checks out to Sanborn Youth Football
         1 Child: $150.00            2 Children: $225.00             3 Children: $275.00 4 Children: $300.00
           I WOULD LIKE TO SPONSOR A TEAM, PLEASE CHECK HERE: (      ). We will call you with DETAILS!
    MANDATORY: PLEASE CHECK ONE: Fundraising Fee of $75.00 ( ) Or SELL QTY 20 $5.00 MONEY CALENDARS (                        )

                  REGISTRATION FEES ARE DUE IN FULL WHEN THIS FORM IS HANDED IN!

                       CHEERLEADING                           (NOTE: GRADE FOR YEAR 2011)
    (PLEASE X GRADE) 1ST: ___*2ND: ___*3RD: ___*4TH: ___*5TH: ___*6TH: ___*7TH: ___ *8TH: ___
                         *PROOF of B IRTH DA TE will be NECESSARY & a less than 2 year physical exam.

                                          PLAYE R           INF ORM ATION
         NAME: ________________________________________________                BIRTHDATE: _____ / ______ / __________

         PHONE # : _________________________________
         ADDRESS: __________________________________________________________________________ _________
FATHER/LEGAL GUARDIAN:__________________________________________CELL:___________________________________
MOTHER/ LEGAL GUARDIAN::________________________________________ CELL:___________________________________
FATHER EMAIL:_________________________________________ MOM EMAIL:_________________________________________
         HEALTH CONCERNS : Please check all that apply to your child. Gi ve details if necessary.
         ( ) Hearing Aid        ( ) Contact Lenses        ( ) Nervous/Easily Upset              ( ) Eye or Vision Impairment
         ( ) Convulsions        ( ) Hearing Disability    ( ) Fainting Spells                   ( ) Breathing Difficulty/Asthma
         ( ) Eye Glasses        ( ) Cardiac Condition     ( ) Allergies (food, insects, Medication)
         ( ) Long Term Medical Care, explain: ____________________________________________________________
         List Specific Allergies :_________________________________________________________________________________
         List Medications Currently Taking:_______________________________________________________________________

         Other:   _____________________________________________________________________________________________
         CHILD’S DOCTOR:           __________________________________________ PHONE #: ___________________________
         HOSPITAL of CHOICE:       __________________________________________ PHONE #: ___________________________

                            S U P P O R T - Please choose one or more – no longer voluntary
(   ) Coach (We will contact you and certify you!) please indicate shirt size: _____ Father ( ) Mother ( )
         ( )    Concession Stand (Everyone will be expected to volunteer at least once)
                ( )       Team Parent (Organization of volunteers for the concession stand & other events for your team)

          THIS IS AN ALL VOLUNTEER P ROGRAM & WITHOUT PAR ENTS HELP THERE IS NO PROGRAM!
PLEASE list the names of TWO (2) PEOPLE who will assume TEMPOR ARY CARE of YOUR CHILD IF YOU C ANNOT BE REACHED.

         NAME: ___________________________________________________                      PHONE #: ___________________

         NAME: ___________________________________________________                      PHONE #: ___________________

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                         Sanborn Junior Indians Football & Cheerleading Organization
                                     PO BOX 1281, Kingston NH 03848
        Sanborn Junior Indians Football & Cheerleading Organization
                         Release and Waiver of Liability and Indemnity Agreement
                                                     (EV ERYONE)
In recognition of the permission granted to the participant named on this form to participate in the YOUTH SPORTS
PROGRAM, I/We SHALL RE LEASE, WAIVE DISCHA RGE AND CONVE NANT NOT TO SUE the Sanborn Y outh Football
& Cheerleading Organization, their agent and employ ees from all liability for any and all loss or damage, and any claim or
demands therefore because of injury to the person or property or resulting in death of the named participant except in the
case of gross or willful wanton negligence of the Sanborn Y outh Football & Cheerleading Organization, its agents and
employee or otherwis e while the named participant participates in the Sanborn Youth Football & Cheerleading
Organization.
I/We further agree to indemnify the Sanborn Youth Football & Cheerleading Organization, their agents and employees
from any and all liability, loss, or damage including but not limited to bodily injury, illness, death or property damage tha t
the Sanborn Y outh Football & Cheerleading Organization, their agents and employees become legally obligated to pay
including reasonable attorney’s fees and costs, as a result of claims, demands, costs or judgments, against the S anborn
Youth Football & Cheerleading Organization, their agents and employees on account of injury to the person or property or
resulting in the death of the named participant except in the case of gross or willful wanton negligence of the S anborn
Youth Football & Cheerleading Organization, their agents or employees and whether or not such liability is sole, joint or
several.
I/We am aware that participation in this program may present a strain on my child’s body, or its parts and therefore I
represent to the Sanborn Yout h Football & Cheerleading Organization that to the best of my knowledge, my child is in a
proper physical condition to allow him/her to participate and that I/We assume the risk of participating.
I/We understand that the above program involves traveling to various sites. I/We will accept full responsibility for the
transportation of my child to and from these activities. I/We release, indemnify, and hold harmless persons providing such
transportation
I/We understand that incase of accident or serious illness, I/We request the Sanborn Youth Foot ball & Cheerleading
Organization to contact me. If the Sanborn Youth Football & Cheerleading Organization or its authorized represent ative is
unable to reach me, I hereby authorize the S anborn Youth Football & Cheerleading Organization to contact the P hysician
indicated on t he front of this form and to follow his/her instructions. If it is impossible to contact this Physician, the
Sanborn Youth Football & Cheerleading Organization may make whatever arrangements necessary.
I/We, the parents/legal guardian, the undersigned, have read this release and understand all its terms. I/We execute is
voluntarily and wit h full knowledge of its significance. I/We have executed this releas e on this date indicated next to
my/our names.

        __________________________________________                          ______________________________
        SIGNATURE OF PARENT/GUARDIAN                   DATE
                         Uniform Policy (Football & Cheerleading)
I/We agree t o return any uniforms and/or equipment owned by the S anborn Y outh Football & Cheerleading Organization
and used by our child while participating in this sport, in the time allotted for the return of these items. I/We further
understand that by not adhering to this policy we will be billed for the replacement costs of these items in the amount of
$300.00 and will be required to secure a deposit of $300. 00 for each future event that our child participates in that is
sponsored by the Sanborn Y outh Football & Cheerleading Organization. Deposit to be returned, wit h no payment of
interest, after rec eipt of Sanborn Youth Football & Cheerleading Organization property.
By my signature below I/We understand and acknowledge this policy agreement between I/We and t he Sanborn Youth
Football & Cheerleading Organization.

        __________________________________________                          ______________________________
        SIGNATURE OF PARENT/GUARDIAN                                        DATE




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