Mini Flag Football Season 2011

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					          Games will be played at Johns Creek Baptist Church Sports Complex,
    conveniently located on McGinnis Ferry road, across from the new Emory Hospital.

      Cost is $50.00** per child and includes t-shirt, flags, and 4 week game schedule
       Registration begins March 1, 2011 and the deadline to register is April 8, 2011
                           Practice begins the week of April 25th
                          Games are April 30, May 7, May 14, and May 21
                   *40 players are needed at each grade level in order to have enough children to play.
        **This is NOT an Upward league. No trophies, gifts or other awards will be given at the end of this season.

          T-Shirt Size (circle one):      YS      YM       YL      YXL/AS        AM      AL       AXL     AXXL

First and Last Name: ___________________________________________________ Gender: M / F

Street Address: _____________________________________________________________________

City:_________________________ State: _____ Zip:____________ Grade: ______ Age: _____

Home Phone: ___________________________ Additional Phone:___________________________

Parent Email: _______________________________________________________________________
                                                       Please PRINT

Parent Names: ______________________________________________________________________

Are you willing to coach your child’s team? (if yes please include your name)____________________________

        Parents, you MUST sign the waiver form on the back in order for your child to participate in this sport.

                               Return form and payment (made payable to JCBC) to:
                                     Ed Rivers at Johns Creek Baptist Church
            6910 McGinnis Ferry Road * Alpharetta, GA 30005 *                    *   678-474-4442

OFFICE USE ONLY!     Date Received: _______________ Paid: __________ Payment Type: ____________
                                                Johns Creek Baptist Church

• I understand I am engaging voluntarily in exercise, physical activity and/or recreational programs.
• It is my responsibility to monitor my own condition throughout any activity or program and, should any unusual symptoms occur,
    I will cease my participation and inform the instructor or coach and staff of the symptoms.
• In the event that a medical clearance must be obtained prior to my participation in a physical activity program, I agree to consult
    my physician and obtain written permission from my physician prior to the commencement of any program.
• I agree to assume the natural risks associated with exercise, sports and physical activity.

• I will not bring weapons, controlled substances or alcohol onto Johns Creek Baptist Church premises or any location being used
    by programs conducted by or with Johns Creek Baptist Church.
• I understand that the use of violence, noise, force, coercion, threats, intimidation, unsafe conduct regarding children, fear, resis-
    tance, insults, or other conduct, intentionally or unintentionally causing disruption or preventing participants ability to enjoy
    their experience or staff’s and/or volunteer’s ability to conduct a program or their job duties, is not acceptable behavior, is in
    conflict with Johns Creek Baptist Church values, and may result in termination from the program and future programs.

•  I HEREBY AGREE TO RELEASE AND HOLD HARMLESS Johns Creek Baptist Church, its employees and volunteer, from any loss, li-
   ability, claim of bodily injury or property damage, or costs which may arise due to my use of the facilities or any facilities where
   programs are conducted and equipment and my participation in programs. This agreement shall be governed by the laws of
• I authorize the use and reproduction of any and all photographs or video footage for Johns Creek Baptist Church promotional

By signing this form, I agree that I have read this entire form and understand my responsibilities for participation and conduct in Johns
Creek Baptist Church programs and activities.

Signature                                                    Name (Please Print)                                          Date


Name(s) of Child/Children


Emergency Contact Information
In case of emergency, please contact:

Name                             Relationship                         Phone                             Cell Phone

Name                             Relationship                        Phone                             Cell Phone