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Wachusett Youth Football and Cheer Registration Form - 2010 Click here to return to the Home Page |
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Click here to return to the Home Page |
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Flag Football Only - |
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The following section must be completed for all Flag Football participants |
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Liability Release and Consent for Medical Treatment (MINOR)
I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Wachusett Youth Flag Football League, and its sponsors and coaches. I authorize the President of Wachusett Youth Flag football the authority to discharge my registration for inappropriate conduct. I and the registrant recognize the possibility of personal injury and damage to personal property associated with the flag football programs and activities (the “programs”). I herby release, discharge and/or otherwise indemnify the Wachusett Youth Flag Football League, its affiliated organizations and sponsors, their associated personnel, including the owners of the 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
I herby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine. This care may be given under whatever conditions are necessary to preserve life, limb, or well being of my dependent.
Please sign below as a Liability Release, Consent for Medical Treatment. |
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Parents Signature: |
Emergency Phone #: |
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Primary Care Physician: |
Phone#: |
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Health Care Provider: |
Provider #: |
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Medical Conditions or Allergies: |
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Medical Certification: All WYFFL participants must deliver to their local Association proof of a Medical Clearance before participating in WYFFL programs. This includes, but is not limited to, Preseason Practice. The Medical Clearance must attest to, or contain the statement |
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“I, (Physician Name) ” hereby my signature below, do certify that I am licensed by the state and am qualified in determining that (Child’s Name ) is physically fit and I have found no medical or observable conditions which would contra-indicate him/her from participating in youth flag football, tackle football, activities. I am therefore clearing this individual for athletic participation without limitation |
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Signature: |
Date: |
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This document is valid for 1 year from the date it was signed |
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