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Flag Football Fees |
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Division |
Grade in 9/2011 |
Early Fee 4/1/11 - 4/30/11 |
Regular Fee 5/1/11 - 5/31/11 |
Late Fee After 6/1/11 |
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Instructional |
K, 1 |
$40 |
$45 |
$80 |
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Freshman |
2, 3 |
$40 |
$45 |
$80 |
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Junior |
4, 5 |
$55 |
$65 |
$100 |
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Senior |
6, 7, 8 |
$55 |
$65 |
$100 |
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Family Max |
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$110 |
$140 |
$200 |
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2011 Wachusett Youth Flag Football League Registration |
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Participant: |
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Last Name |
First Name |
MI |
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Address |
Town |
State |
Zip |
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Date of Birth / / |
Grade in fall ‘11 |
Last year’s team / division |
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Parent/Guardian: |
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Last Name |
First Name |
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Phone #: |
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Interested in sponsoring a team YES o |
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Mail completed registration forms and payment to: WYFFL, P.O. Box 689, Holden, MA 01520 |
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If you have questions, see our website at www.wachusettflagfootball.com |
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The following section must be completed for all Flag Football participants
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 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. |
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Please sign below as a Liability Release, Consent for Medical Treatment.
Parents Signature
Emergency Phone #
Primary Care Physician
Phone#
Health Care Provider
Provider #
Medical Conditions or Allergies
This document is valid for 1 year from the date it was signed
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