East Limestone Youth Football and Cheerleading Application

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1 East Limestone Youth Football and Cheerleading Application Date: Check# Cash Amount Returning Player Yes No Participants Name: Phone: Home Address: City: Zip: Father s Name: Work Phone: Cell: Mother s Name: Work Phone: Cell: EMERGENCY CONTACT NAME /PHONE: MEDICAL CONCERNS RELATED TO FOOTBALL/CHEER: PARENTAL SECTION (Authorization, Waiver and Consent): I/we the parent(s)/guardian of the above named applicant to the East Limestone Youth Football Association (ELYFA) hereby give my/our approval of said applicant s participation in and all activities during the current season. I/we understand that there are certain risks of injury inherent in the practice and play of this sport, as well as in traveling and other related activities incidental to the applicant s participation, and I/we are willing to assume these risks. I/we will accomplish an applicant sports physical and provide ELYFA official documentation prior to practice commencing. I/we certify that the applicant is fully capable of participating in this sport and that he/she is healthy and has no mental disabilities or infirmities that would restrict full participation in these activities except as listed above. In addition to giving full consent for participation, I/we do hereby waive, release, and hold harmless ELYFA, it s officers, coaches, sponsors, supervisors, and representatives for any injuries that may be suffered by the applicant in the normal course of participation in this sport and activities incidental thereto whether the result of negligence or any other cause, except to the extent and in the amount covered by accident or liability insurance. I/we will furnish a certified Birth certificate of the above named applicant upon request by Association officials. I/we will be financially responsible for equipment issued to the applicant other than the normal wear and breakage during games and practices and I/we will reimburse ELYFA or its respective member association for the loss and damage to the equipment. I/we give permission to ELYFA and/or its member associations to validate participant s school grades. I/we certify that to the best of my/our knowledge, all the above information is accurate and correct and that any false information may be cause for disqualification of applicant. I/we certify the above named applicant is scholastically able to participate. I/we will participate in any and all work days assigned to the team the above named is assigned. All registration fees are non-refundable. Parent/Guardian Signature X EMERGENCY MEDICAL: I/we the parent of the above named applicant give our permission for any emergency treatment necessary either on the practice field or on the game field. I/we authorize any hospital and/or physician to perform emergency treatment for any injuries resulting from any scheduled East Limestone Youth Football Association functions including the supervised travel to and from said function. SPORTS PHYSICAL: I/We understand the requirement of a sports physical that must be completed within 6 months of July 1, 2017 BEHAVIOR POLICY: I/we have received and read a copy of the East Limestone Youth Football Association Misbehavior Policy for Parents and Players. FOR ASSOCIATION USE ONLY Date of Birth Age as of 08/31/17 Weight Older/Lighter? Yes No Birth Certificate Physical School attending fall 2017 Fundraising: Yes No Shoulder Pads size Helmet size Football/Cheerleader Division Team **** THERE WILL BE A $30.00 FEE FOR ANY RETURNED CHECKS****

2 East Limestone Youth Football Association Program Acknowledgements We/I, parent(s) of, acknowledge that East Limestone Youth Football Association herein known as ELYFA is a not for profit organization formed for the explicit purpose of developing leadership and promoting good citizenship to the youth of the East Limestone Community through athletic competition. Please initial each square and sign your signature below to acknowledge that you understand that this program s success is dependent upon the physical and emotional support of parent volunteers. Initial Admission Most regular season games are played on Saturdays between 8am and 5pm. Tournament and rained out games may be scheduled on weekdays. There will be an admission fee for all game locations for adults and kids 5 & up. [Note: NO SMOKING, DRINKING, PETS, SCOOTERS, SKATES OR BIKES ARE ALLOWED AT ANY GAME or PRACTICE LOCATION.] Equipment I am responsible for the timely return of all assigned equipment. I understand that I am financially responsible for all equipment lost or damaged outside the normal scope of use. Team Assignment Teams are assigned by the ELYFA board and parents/players cannot request a coach. Every effort will be made to keep teams together and meet logistic requirements of the parents/players, but all needs may not be met due to team size, etc. Field Support/Work Day Each player s parent/adult representative may be called upon to volunteer for various activities on behalf of the team. Such activities include but are not limited to, field preparation, facilitating tournament activities, working on the chain gang, concessions, gate, cleanup, etc. Fundraising to Offset Registration By initialing here, I am agreeing to fundraising efforts to offset my registration price. By doing so, I agree that an administrative cost of $20 for the TV will be added to the registration fee. The $20 is included when the full amounts of tickets are sold (70 tickets for football and 65 tickets for cheer registrations). If I do not sell the full 70 or 65 tickets, I acknowledge that the $20 will be deducted from the amount of money earned by selling tickets and this total is the amount that will be used to offset my registration. Signed: Parent/Guardian Date

3 Player Behavior Policy: East Limestone Youth Football Association (ELYFA) seeks to encourage good sportsmanship, fair play and team spirit among all of its players. Because the Association is about working with 5-12 year old children, occasional lapses in behavior of the players are to be expected. However, repeated misbehavior which violates the basic spirit that ELYFA and its players are striving for, will not be tolerated. Examples of such misbehavior include, but are not limited to, repeated verbal abuse of teammates, coaches, spectators or opponents, repeated use of profanity, aggression toward any other players, particularly physical aggression, and repeated refusal to cooperate with the coaches or league officials including the referees. Any such behavior when observed by an ELYFA Board member or reported in writing by an ELYFA coach, parent, or spectator, will result in a review of the incident by the Board. The Board can recommend any action taken for or against the misbehaved player. For a valid first infraction, a warning will be issued to the player and sent to his/her parents. Further actions may be recommended if the Board deems appropriate. All action will be Board approved. If the player is involved in further incidences, automatic suspension for a set number of games is a likely recommendation by the Board. After any suspension, a player-parent Board conference is required before the player can resume play. If the player is allowed to continue to participate after suspension, and misbehavior continues beyond this, the Board will be free to suspend the player for the remainder of the year with no reimbursement of the registration fee. Any suspension will result in disqualifying the player from any post-season play. It is the intent of East Limestone Youth Football Association to create an atmosphere where all player participants can have fun, learn football/cheerleading, and most of all develop the attitudes and good behavior associated with team sportsmanship and fair play. Parents Behavior Policy: This policy is intended to describe the procedure that East Limestone Youth Football Association will follow to address any instances. It is not the intent of this policy to try and define every instance that might be described as constituting parental misbehavior. We will, however, make mention to certain types of known behavior that we have experienced in the past and will use these examples to illustrate unacceptable parental behavior. Such examples are, but not limited to, the following: 1) Boisterous taunting of referees, coaches, league officials or players in a negative manner. 2) The use of profanity, vulgar or demeaning language. 3) Embarrassing, negative remarks aimed at your own child while he /she is playing a game. 4) The use of Alcoholic beverage while at any football field. 5) Threatening of aggressive remarks towards referees, coaches, league officials, players or fans. 6) Physical confrontations with referees, coaches, league officials, players, or fans. 7) Failure to remove yourself from the field, after you have been ejected from the stands. 8) Failure to remove yourself from any area around the field, after you have been ejected from those areas. Parents please understand that any such behavior as listed above will be dealt with by ELYFA in the following manner: You will first be addressed by your coach and asked politely to calm down. If you should persist then you will be warned by the officials officiating the game to control your behavior. If you continue to present a problem you will be ejected from the game and the game will not resume until you have left the premises. If you fail to leave the premises, a league official will be summoned to escort you away from the playing field. You will be allowed a chance to vent your frustrations and asked to cool down. If you cannot do so then you will be ejected from the football field area. If you fail to do so and refuse to calm down, the Limestone County Sheriff Department will be called to arrest you and take you from the school property. It is our hope that we do not have to initiate any of the above steps necessary to control parental behavior. It is the intent of East Limestone Youth Football Association to create a family atmosphere for the enjoyment and recreation of hundreds of parents, coaches and players who are out to enjoy team and family time together. We hope to provide the bases for all players to have fun, learn the game of football/cheerleading and most of all develop the attitudes and good behavior associated with sportsmanship, fair play and team work. We are asking you as parents to help us reach our goal. Please lead by example and remember that hundreds of small eyes and ears are looking and listening to everything you say and do East Limestone Youth Football Association

4 ALABAMA HIGH SCHOOL ATHLETIC ASSOCIATION Preparticipation Physical Evaluation Form History Date Name Sex Age Date of birth Address Phone School Grade Sport Explain Yes answers below: Yes No 1. Has a doctor ever restricted/denied your participation in sports? 2. Have you ever been hospitalized or spent a night in a hospital? Have ever had surgery? 3. Do you have any ongoing medical conditions (like Diabetes or Asthma)? 4. Are you presently taking any medications or pills (prescription or over the counter? 5. Do you have any allergies (medicine, pollens, foods, bees or other stinging insects)? 6. Have you ever passed out during or after exercise? Have you ever been dizzy during or after exercise? Have you ever had chest pain or discomfort in your chest during or after exercise? Do you tire more quickly than your friends during exercise? Have you ever had high blood pressure? Have you ever been told that you have a heart murmur, high cholesterol, or heart infection? Have you ever had racing of your heart or skipped heartbeats? Has anyone in your family died of heart problems or a sudden death before age 50? Does anyone in your family have a heart condition? Has a doctor ever ordered a test on your heart (EKG, echocardiogram)? 7. Do you have any skin problems (itching, rashes, staph, MRSA, acne)? 8. Have you ever had a head injury or concussion? Have you ever been knocked out or unconscious? Have you ever had a seizure? Have you ever had a stinger, burner, pinched nerve, or loss of feeling or weakness in your arms or legs? 9. Have you ever had heat or muscle cramps? Have you ever been dizzy or passed out in the heat? 10. Do you have trouble breathing or do you cough during or after activity? Do you take any medications for asthma (for instance, inhalers)? 11. Do you use any special equipment (pads, braces, neck rolls, mouth guard, eye guards, etc.)? 12. Have you had any problems with your eyes or vision? Do you wear glasses or contacts or protective eye wear? 13. Have you had any other medical problems (infectious mononucleosis, diabetes, infectious diseases, etc.)? 14. Have you had a medical problem or injury since your last evaluation? 15. Have you ever been told you have sickle cell trait? Has anyone in your family had sickle cell disease or sickle cell trait? 16. Have you ever sprained/strained, dislocated, fractured, broken or had repeated swelling or other injuries of any bones or joints? Head Back Shoulder Forearm Hand Hip Knee Ankle Neck Chest Elbow Wrist Finger Thigh Shin Foot 17. When was your first menstrual period? When was your last menstrual period? What was the longest time between your periods last year? Explain Yes answers: I hereby state that, to the best of my knowledge, my answers to the above questions are correct. Signature of athlete Date Signature of parent/guardian DUPLICATE AS NEEDED Rev FORM 5 Page 1 of 2

5 Preparticipation Physical Evaluation Physical Examination Rule 1, Sec. 14 In order for a student to be eligible for interscholastic athletics, there must be on file in the Superintendent s or Principal s office a current physician s statement certifying that the student has passed a physical exam, and that in the opinion of the examining physician (M.D. or D.O.) the student is fully able to participate in interscholastic athletics (Grade s 7 12). The AHSAA Physicians Certificate (Form 5) must be used. A physical exam will satisfy the requirement for one calendar year through the end of the month from the date of the exam. For example, a physical given on May 5, 2015, will satisfy the requirment through May 31, Height Weight BP / Pulse Vision R 20 / L 20 / Corrected: Y N LIMITED Cardiovascular Pulses Normal Abnormal Findings Heart Lungs Skin E.N.T. Abdominal Genitalia (males) Musculoskeletal Neck Shoulder Elbow Wrist Hand Back Knee Ankle Foot Other Clearance: A. Cleared B. Cleared after completing evaluation/rehabilitation for: C. Not cleared for: Collision Contact Noncontact Strenuous Moderately strenuous Nonstrenuous Due to: Recommendation: Name of physician Date Address Phone. Signature of physician, M.D. or D.O.

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