Satsuma Youth Football Registration

Participant Full Name

First NameLast Name

Date of Birth

Date

Upcoming Grade

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Full Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Alternate Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact

First NameLast Name

Relationship

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Existing Medical Coverage Provider

Medical #

Medical Insurance Card UPLOAD

Known Allergies

Current Medical Conditions

Medications

Jersey Size *We will confirm with in-person sizing*

Games Pants Size *We will confirm with in-person sizing*

Compression Shirt Size *These are a compressed, small fit*

Practice Shorts Size

Jersey Number *Option 1*

Jersey Number *Option 2*

Jersey Number *Option 3*

I am available to help coach

I hereby voluntarily permit me or my child to participate in Satsuma Youth Football Development. I UNDERSTAND AND FULLY ACCEPT THAT THERE ARE RISK INVOLVED IN SPORTS, AND THAT ACCIDENTS AND INJURIES ARE COMMON AND ARE ORDINARY OCCURRENCES OF SPORTS. I HEREBY AGREE TO ACCEPT ANY AND ALL RISK OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE.

As consideration for being permitted by SYFD to participate in these activities, I hereby release and hold harmless Satsuma Youth Football Development, staff, volunteers, designated coaches, the City of Satsuma, and program officials from all liability, and from all actions or claims that I or my child now or hereafter have damage or injury to me or my child, or to any person or property, resulting from the negligence or other acts of any employees or volunteers in the connection with my child’s participation. I further agree that this waiver, release and assumption of risks is to be binding on the heirs and assigns of the undersigned. I further agree to indemnify and hold SYFD (its officers, employees, agents, and volunteers) free and harmless from any loss, liability, damage, cost or expenses which they may incur as a result of any injury and/or property damage that I or my child may cause or sustain while participating in this activity. In case of a medical emergency, I hereby give permission to SYFD staff, trainer, and volunteers to order treatment for me or my child, including any necessary medical treatment and x-rays. I also hereby give permission to SYFD staff and volunteers to disclose the information contained on this form to medical personnel. I understand that an attempt will be made to reach me by phone when a diagnosis is completed. I agree to pay all medical, hospital, or other expenses which my child or I may incur as a result of such treatment. SYFD also does not provide any medical or other insurance protection or benefits for those who participate.I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND THE SATSUMA YOUTH FOOTBALL DEVELOPMENT AND SIGN IT OF MY OWN FREE WILL.

Date

Registration Payment

3rd & 4th Grade *Payment in FULL* Football Registration

3rd and 4th Grade Team

$175.00 Quantity

5th & 6th Grade *Payment in FULL* Football Registration

5th and 6th Grade Team

$175.00 Quantity

Cash/Check/Venmo in Person DUE BY JUNE 22nd @ Meeting

$175 (no money collected online)

Free Quantity

Total

Payment Methods

Choose from one of the PayPal options to make your payment.