Name On Jersey *
Players last name for Jersey
* Phone * Date of Birth *
Age as of 7/31 * Weight * Parent/Guardian Name *
Grade in Fall * K 1 2 3 4 5 6 7 8 9 School in Fall * School Phone * Home Email Address *
Medical Insurance (select one) * Name of Insurance Carrier Policy # Football or Cheer - Choose One * Permission to Participate *
I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand that participation in football, cheerleading, dance and/or step may result in SERIOUS INJURIES, PARALYSIS, PERMANENT DISABILITY AND/OR DEATH. Furthermore, I fully acknowledge and understand that protective equipment does not prevent all participant injuries. I, the parent/guardian of the above-named participant, do hereby give my approval for my child/ward to participate, and further assert that I have verified with my child/wards physician, and in my opinion, my child/ward is physically fit and can participate without limitation in any and all Local, Regional, National, League/Conference, Association and team/squad activities, including transportation to and from the activities by a licensed driver.
No Refund Policy *
I fully agree and understand that all registration fees paid to Jensen Beach Football and Cheer are deemed to be 100% nonrefundable.
HELMET WAIVER (for football participants)
We acknowledge, AND WE understand the risks involved in my CHILD/WARD, my playing FOOTBALL, which is a collision sport; the NOCSAE committee has adopted the following warning to be read by, and signed by, both the parent/guardian and participant. DO NOT USE THIS HELMET TO BUTT, RAM OR SPEAR AN OPPOSING PLAYER, THIS IS IN VIOLATION OF FOOTBALL RULES AND CAN RESULT IN SEVERE HEAD, BRAIN OR NECK INJURY, PARALYSIS OR DEATH AND POSSIBLE INJURY TO YOUR OPPONENT, THERE IS A RISK THAT THESE INJURIES MAY ALSO OCCUR AS A RESULT OF AN ACCIDENTAL CONTACT WITHOUT INTENT TO BUTT, RAM OR SPEAR, NO HELMET CAN PREVENT ALL SUCH INJURIES.
Equipment Uniform Responsibility *
I agree to be financially responsible for any lost of damaged equipment and agree to providing a security deposit of $200.00 that will be forfeited for any lost or stolen equipment.
Code of Conduct *
The Ideology Of Youth Sports Including This Program Is To Promote Good Understanding And Fundamental Knowledge Of The Sport. It Is Also Critical That Good Sportsmanship Including The Ability To Always Conduct Oneself In An Appropriate Manner Of Positive Accord Both On And Off The Field. It Is Understood That Any Incident Considered Detrimental To The Pursuit Of This Ideology Will Not Be Tolerated. It Will Be Addressed In Accordance With The Statutes Of The Association, Conference, Current National Affiliation, State and Local Laws, And May Result In Dismissal From The Program And The Inability To Participate In Any Future Related Activities Of The Association. This Code Of Conduct Applies To All Involved With The Program Including But Not
Limited To, The Football Players, Cheerleaders, Spirit Participants, Parents And Guardians.
Parent/Guardian Name: *
Parent/Guardian Signature *