FLAG FOOTBALL REGISTRATION FORM
A NON CONTACT SPORT
2012Ho-Ho-Kus / Saddle River Football Cheerleading Association
In person registration Saturday March 10thMarch 17thfrom 10am to 12noon at
HHK School MPR
Fee: $85.00
Name______Birthdate______
Address______Grade______(in September 2012)
Home Phone # ______Emergency Cell # ______* Required
EMAIL ______* Required
T shirt Size ______(youth S, M, L)
Is Applicant playing instructional soccer ______
Coaches are needed to help with this program, please indicate below if you are willing to help coach.
Name and Phone # ______
The Association Does Not Carry Medical Insurance. Parents Must Assume All Responsibility. I, the parent or guardian of the above named participant accepts the offer of the Ho-Ho-Kus/Saddle River Football/Cheerleading Association to provide supervised football games and practice for the boys and girls. I assume all the risks and hazards incidental to such activities. I hereby release the Ho-Ho-Kus/Saddle River Football/Cheerleading Association, the organizers, the sponsors, the supervisors, and any person transporting my son or daughter to or from any activities, from any claim or liability in case of injury to my son or daughter. I hereby certify that my son or daughter has no medical condition, which would prevent or make hazardous or unsafe his or her participation in the activities of the Ho-Ho-Kus/Saddle River Football/Cheerleading Association. I further certify that I will give to the Ho-Ho-Kus Football/Cheerleading Association written notice of any physical or mental condition, which may hereafter affect my son or daughter. I hereby certify that I have read the reverse side of this form and accept the terms and conditions therein. Before signing, please verify the accuracy of the data in order to assist in the prompt registration of all the applicants.
Signature: ______Printed: ______
Amount Paid: ______Check# ______Date: ______
Flag Director: Dan Burns Cell 917-826-4514….
Ho-Ho-Kus / SaddleRiver Football – Cheerleading Association
Consent, Release, Waiver and Indemnification Agreement
As the parent and / or legal guardian of the named child, I hereby consent to my child’s participation in all activities of the Ho-Ho-Kus / Saddle River Football – Cheerleading Association (“The Association”). This consent is given with full knowledge that participation may involve risks as SERIOUS BODILY INJURY, PERMANENT DISABILITY or DEATH. These risks may be foreseeable or unforeseeable. They may occur while participating in an activity or traveling to or from an activity. The risks may have economic consequences. I accept the assumption of these risks.
I expressly represent that my child is in good health, proper condition and has no physical or psychological condition which may adversely impact his / her participation except as set forth below. * I further represent that I will immediately provide written notice to the Association of any change of condition which may adversely impact his / her participation. In the event that there is a physical or psychological condition, I agree to accept the good faith determination of the Association as to whether and to what extent my child may participate, which determination shall be made in accordance with applicable law.
I, on behalf of myself, my child, and our next of kin, heirs, successors, and assigns hereby VOLUNTARILY and KNOWINGLY RELEASE and WAIVE any and all CLAIMS against the Association, its directors, officers, coaches, organizers, sponsors, lessors, supervisors, players, parents, and any and all other persons and / or entities (collectively “Releases’) arising from any event or occurrences of any nature or of any kind related to my child’s participation in activity, or any travel to or from same, and / or a determination that my child may not participate. This RELEASE and WAIVER includes, but it is not limited to, determinations, actions or inactions, and / or rescue efforts allegedly negligent or otherwise.
I agree to indemnify, save and hold harmless the Association and Releases and against my claim or threat of claim asserted on behalf of, deriving from, of related to my child. This shall include costs of defense, attorney’s fees, expert’s fees, damages, and / or any other costs or expenses as they may arise.
I further represent that I have carefully read this CONSENT, RELEASE, WAIVER and INDEMNIFICATION AGREEMENT, have had sufficient time to contemplate and to understand its terms, and voluntarily execute same to evidence my agreement.
Date: ______Name: ______
*If there is an exception, please provide a brief summary: