Carlisle Pee Wee Football

Participation and Parent/Guardian Agreement

Name of Player *

First

Last

Player's Current Age *

Player's Date of Birth *

Grade (Next Year) *

Please select the grade your child will be playing for this fall.

Requested Number:

*** Please note that this is a REQUEST and is NOT guaranteed ***

Are you registering more than 1 player with Carlisle Pee Wee Football?

Primary Parent/Guardian's Name *

First

Last

Phone *

Email *

Primary Parent/Guardian's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Secondary Contact Name

First

Last

Secondary Contact Phone

Emergency Contact *

First

Last

Emergency Phone *

Name of Doctor/Pediatrician (or Practice Name) *

Phone *

Name of Dentist (or Practice Name) *

Phone *

Preferred Hospital *

Phone *

I will obey the official rules and regulations of the Carlisle Pee Wee Football Association, code of conduct, and the Southwestern Buckeye Pee Wee football league.

1. All football equipment issued to the player shall be worn only to a scheduled football practice, scrimmage, or game. The only exception being the game jersey of the week may be worn to school on Friday, and to the High School game on Friday night.

2. Equipment will not be mishandled or abused.

3. Any helmet willfully damaged or destroyed by the player will be repaired, or replaced, by the player's parent and/or guardian.

4. Any jersey willfully damaged or destroyed by the player will be repaired, or replaced, by the player's parent and/or guardian.

5. Any shoulder pads willfully damaged or destroyed by the player will be repaired, or replaced, by the player's parent and/or guardian.

6. Any equipment not turned in by the player, will be replaced by the player's parent and/or guardian at the cost of a new replacement.

The conditions of this agreement do not apply to normal equipment damage incurred during participation in a practice session, or a scheduled game or scrimmage.

I hereby certify that I am the parent and/or guardian of the player listed above and that such child has passed a physical examination within the last year and is, to the best of my knowledge, physically fit. I hereby consent to such child competing in the Carlisle Pee Wee Football Program and I will not hold the Association or Southwestern Buckeye Pee Wee Football League responsible for any injury sustained while participating in the program. I also certify that this child is covered by Medical and Hospitalization on my family policy or other insurance.

All equipment shall be returned cleaned, or parents may be charged $15.00 for cleaning.

I agree to all of the terms above. *

Yes

Total

$ 0.00

Please click "Pay Now" to complete registration. You will be redirected to PayPal for payment. You can login with your personal PayPal account, or select "Pay with Debit or Credit Card" if you do not have a PayPal account.

Registration

Carlisle Pee Wee Football

Participation and Parent/Guardian Agreement