Deerfield Community Center

Dogs Youth Football 2008

Registration will be held at 6-8 PM on April 9, 2008 at the Deerfield Community Center

 

League registering for: (Please circle one)    5 th/ 6 th Grade               7 th Grade                   8 th Grade

                                                                                  Level                         Level               Level

 

 

Player's Name ____________________________Grade                 Age _____      Birthday           ________

 

Registration Cost   $85.00 per player (Maximum of $170.00 per family) add late fee of $10 if after April 9

 

Address                                                                                  City                                                        Zip Code_________

 

Medical Information (Allergies, Asthma, etc.) ________________________________________________

 

Parent/Guardian’s Name(s) _______________________________________________________________

 

Home Phone ___________Cell Phone__________ Work Phone ___________Email   _________________

 

Did you receive a new jersey last year?_____   If no, what size and number would your  child like?  Jersey Size Needed:  ______Number________

 

VOLUNTEER INFO: EACH FAMILY MUST VOLUNTEER FOR ONE OF THE FOLLOWING ACTIVITIES OR ADD $10 TO ABOVE FEE.

 

What is your interest?   Coaching      Assistant Coaching    Fundraising Committee

During games:  Sideline Marker (need 3 people/game)      Score-clock Operator       Game Announcer       Field Setup   Field Takedown    Concessions      

 

Please provide us with emergency contact information if you are not available:  ______________________

                                                                           IMPORTANT

Please read and sign the following:

I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Deerfield

Community Center (the "DCC"), its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with youth programs (the "Programs") and in consideration for the DCC accepting the registrant for its Programs and activities, I hereby release, discharge and/or otherwise indemnify the DCC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

 

                                                                                                                                                                                                                 

Printed Name of Parent/Legal Guardian                           Signature                                                               Date       

Text Box: DEERFIELD COMMUNITY CENTER OFFICIAL USE ONLY Registration fees: Player's fee:            $ _________    Added to database                TOTAL:                     $ _________   Check number:                                                                                                 

 

 

 


 

                                                                Return form to: DCC, 3 W. Deerfield, PO Box 404, Deerfield WI 53531