Football Registration

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2012 Football Registration Info

2012 Meadowdale Jr Football Registration

*** To be eligible for for the Meadowdale Youth Football program, a player must between the ages of 5 - 14 & not attend high school and have an established residence in the service area of Meadowdale High School or have been apart of our program Before 2011. ***

Player Information
First Name: *
Last Name: *
Address: *
City: *
Zip Code: *	(5 digits)
Date of Birth: *
Height: Ft & In: *	For jersey sizing purposes
Weight: lbs: *	For jersey sizing purposes
Fall 2012 School: *
Fall 2012 Grade: *
Are you requesting a playdown spot?:
Jersey # Choices:
Parent 1 Information
First Name: *
Last Name: *
Parent 1 Home Phone: *
Parent 1 Cell Phone: *
Parent 1 Email Address: *
Parent 2 Information
Parent 2 First Name: *
Parent 2 Last Name: *
Parent 2 Cell Phone: *
Parent 2 Email Address: *
Waivers
Liability Waiver: I have read the following and give my consent	Liability Waiver: AS the parent (or legal guardian) of the above named minor, I grant permission for the minor to participate in all activities of the sports program. I assume all risk and hazards incidental to such participation, including transportation to and from such activities, and do hereby release and waive all claims against Meadowdale Mavericks Jr Football,MYS, Sponsors, volunteers, agents and other participants.
HB 1824 Compliance Statement I have been provided with information on concussions	HB 1824 Compliance Statement I have been provided with information on concussions in youth sports. If the player is suspected of a Head injury or Concussion, the player will be removed from play. The player will be kept from play until given permission to return to play by a health care provider. www.cdc.gov/ConcussionInYouthSports
Medication Authorization / Grant of Consent Medication Authorization / Grant of Consent	Medication Authorization / Grant of Consent I hereby certify that my child is in good health and may participate in all activities. In case of an emergency, I give my permission for my child to be given emergency treatment at any responsible accessible hospital.

Payment Method:(In what way do you intend to pay)

Security Code: *