Registration

- Step 1 of 4

Carlisle Pee Wee Football

Participation and Parent/Guardian Agreement

How many players are you registering for Carlisle Pee Wee Football this year

Player Name *

First

Last

Player's Current Age *

Player's Date of Birth *

Grade (Next Year) *

Player's Requested Number

Please note that this is a request, and is not guaranteed.

Jersey Options *

Second Player's Name *

First

Last

Second Player's Current Age *

Second Player's Date of Birth *

Second Player's Grade (Next Year) *

Second Player's Number Request

Jersey Options (Second Registrant) *

Third Player's Name *

First

Last

Third Player's Current Age *

Third Player's Date of Birth *

Third Player's Grade (Next Year) *

Third Player's Number Request

Jersey Option (Third Registrant) *

Total

$ 0.00

Primary Guardian/Parent *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact *

First

Last

Emergency Contact Phone *

Name of Doctor/Pediatrician *

Phone *

Name of Dentist *

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: *

Signature *

Total

$ 0.00