GENERAL INFORMATION Child's Name Phone Address City Zip Date of Birth GenderMaleFemale Age7u8u9u10u11u12u13u Grade next season Weight Helmet Size Shoulder Pad Size Did you play KYSA sports last year?YesNo Willing to help coachYesNo MEDICAL EMERGENCY INFORMATION Emergency Contact Phone Name of Physician Phone Drug Allergies / Specific Medical Problem PARENT INFORMATION Parent / Guardian Name Address City Zip Home Phone Work Phone Cellphone Alternate Phone Email Alternate Email Permission & Release I hereby certify that all information about afore said player has been filled in and is true and correct. I realize this football/cheerleading team program is a non-profit organization. This a voluntary program instituted for the benefit of the children in our community and I therefore, hereby agree o hold no party connected with the team activities responsible for injuries to my child during normal pursuit of said activities. If my child is injured during football play, cheerleading, or in conjunction wih this sport, I hereby authorize the coach or manager of his/her team to obtain medical attention as he/she may need including surgery for an emergency. I agree to pay all medical and hospitals cost for my child's treatment, In the event you are unable to reach out physician listed shove, treatment maybe rendered a clinic or hospital that has been designated by the North Central Pee Wee Football League or its designee. Δ
