NEYSA Football Cheerleading 2011

Player Name: _________________________________________ Birth Date: ____________ Age: _________

School: _________________________________________________ Grade: ________

Parent (Guardian) Name(s): _________________________________________________________________________

Address: ________________________________________City:_____________________Zip:_____________

Phone: ____________________ Cell Phone: ___________________ E-mail: ___________________________

As the parent\guardian of _____________________________________, a NEYSA cheerleader, I\we will take full responsibility for the NEYSA cheerleading uniform. I acknowledge that the uniform is to be worn ONLY to games. If the uniform should get lost, stolen, ruined, or permanently marred, I\we take full responsibility for it and will pay NEYSA for the current replacement.

____________________________________________________________________

Name Date

I/We release NEYSA, Northeastern School District, their affiliates, employees, and volunteers from any personal injury, accident or other claims resulting from my/our child's participation. I/We agree to indemnify and hold harmless the above named organizations, affiliates, employees, and volunteers from such claim, liability, legal action, and all attorney fees which are or could be claimed by my/our child or by me/us. I/We intend to be legally bound.

____________________________________________________________________

Name Date

My child has the following allergies/medications: ________________________________________________

My child has the following health/physical concerns: _____________________________________________

Hospital preference: York / Memorial (Circle one)

In Case of Emergency:

Contact Person (other than parent) __________________________________________________________________

Relationship: __________________________________________ Phone ____________________________________

UNIFORM SIZE:

Top: ____________ Skirt: ___________

Jacket & Pants filled out separately. Please complete & hand in with this form

VOLUNTEER OBLIGATIONS: Please check at least one with which you can help. This entire organization is operated entirely by volunteers. Please do your part to help make things run smoothly.

_____ Coach ____ Asst. Coach _____ Team Mom ____ Concessions

NEYSA Use Only:

Registration fee received? Date: __________ Check # __________/Cash Amt: __________

Code of Conduct signed? Y _____ N ______

Camp? ____________ deposit ______________ paid in full_____________