FEES: CHEER: $250 FLAG FOOTBALL: $75 TACKLE FOOTBALL: Before 1 Mar 2012 - $175 DEPOSIT: $50

After 1 Mar 2012 - $200

* Multi – Player Discount for FOOTBALL ONLY. $25 Off the Registration Fee for each sibling as long as they are all registered at the same time and deposits or full payment paid at the time of registration for all.

* A Paid Deposit holds a roster spot for the participant until the date full payment is due. Rosters will be filled on a first come first served basis and roster sizes are limited by TYFA. Payments can be made on the remaining balance at any time up until the Full Payment is Due. For the Fall 2012 Season the Full Payment is due by 15 June 2012.

Send Completed - Signed Registration Form and Payments To: Dale Seitter

906 Wagon Wheel Dr

Copperas Cove, TX76522

Make Checks/Money Orders Payable to: KILLEEN CHIEFS

* $20 charge for returned checks and NO roster spot secured until the returned check amount and $20 fee are paid in cash.

** ALL DEPOSITS/PAYMENTS MADE TO THE KILLEEN CHIEFS ARE NON-REFUNDABLE **

CIRCLE ONE: (Age as of 1 Aug 2012)

FOOTBALL: FLAG (5-6 yrs old) TACKLE: MIDGET(*6-7 yrs old) ROOKIE(8-9 yrs old) JUNIOR(10-11 yrs old)

* 6 years old are strongly encouraged to have at least one year of previous organized football experience before playing tackle.

* TYFA is a Non-Weight Restrictive and No Mandatory Play Rules League

CHEER: MASCOT(4 yr olds) FLAG(5-6 yrs old) MIDGET(7 yrs old) ROOKIE(8-9 yrs old) JUNIOR(10-11 yrs old) SENIOR(12-13 yrs old)

CHILDS NAME: (first)______(middle)______(last)______

DATE OF BIRTH: (MM/DD/YYYY): ______AGE ON 8/1/12: ______

HOME PHONE: ______CELL PHONE: ______

FALLSCHOOL: ______

PARENT/GUARDIAN NAME: ______

ADDRESS:______CITY:______STATE: ______ZIP: ______

EMAIL ADDRESS:______

CHILDS T-SHIRT SIZE: S ( 6/8)_____ M ( 8/10)_____ L (10/12)_____ AS _____ AM_____ AL_____ AXL_____

T-Shirt sizes tend to run small. The size you put on the order form will be the size that your child will receive.

JERSEY NUMBER REGUEST: 1.______2. ______3.______(We cannot guarantee you will get your requested number)

PREVIOUS EXPERIENCE: _____YES ______NO WITH WHOM: ______

SIBLINGS REGISTERED:

NAME:______AGE:______SPORT:______

NAME:______AGE:______SPORT:______

NAME:______AGE:______SPORT:______

IS THIS CHILD COVER BY INSURANCE?: ______YES ______NO

____ INSURANCE WAIVER: I, the Guardian of this child, do not have my own Health/Injury insurance coverage. I assume all risk and hazards incidental to such participation without Health/Injury coverage and do hereby waive, release, absolve, indemnity and agree to hold harmless, TYFA, Killeen Chiefs, the sponsors, supervisors, participants, volunteers and persons involved with TYFA.

EMERGENCY CONTACT INFO: NAME:______PHONE:______

__YES ____NO – MY CHILDS PICTURE OR LIKENESS MAY BE DISPLAYED ON THE TYFA/ KILLEEN CHIEFS WEBSITE

I, the Guardian of the above named child, hereby give my approval to his/her participation in any and all TYFA Football/Cheer activities during the current season. I understand that football as well as cheerleading is a dangerous sport that may result in serious injury or even death. I assume all risk and hazards incidental to such participation including transportation to and from such activities, and I do hereby waive, release, absolve, indemnity and agree to hold harmless TYFA, the Killeen Chiefs, the sponsors, supervisors, participants, volunteers and persons transporting my child to and from activities for any claim arising out of injury to my child.

Parent/Guardian Signature:______Date:______

In signing this form I understand that under TYFA regulations I have committed my child to the Killeen Chiefs. I am not permitted to sign with another TYFA organization unless I formally withdraw from the Killeen Chiefs. Under TYFA regulations it is tampering if the use of inappropriate influence or special inducement by anyone associated with a TYFA organization in an attempt to encourage a youth or volunteer who is currently registered with or transfer to their organization. Money does not have to exchange hands to be registered.

THANK YOU

Dale Seitter

Executive Director

Killeen Chiefs Competitive Youth Sports Association (KCCYSA)

(210) 870-8579

Parents Introduction to TYFA