Roy-Hart L.O.Y.A.L. Football and Cheerleading Registration
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1 Roy-Hart L.O.Y.A.L. Football and Cheerleading Registration FEES: REGISTRATION $65(1st CHILD) $60(2nd CHILD) $55(each CHILD thereafter) $75(1st CHILD) $70(2nd CHILD) $65(each CHILD thereafter) AFTER JUNE 10, 2017 NO EXCEPTIONS This section to be completed by Parent/Guardian: Full Name of Participant Gender M or F (First) (Middle) (Last) Circle One: FOOTBALL OR CHEERLEADING HAS THE CHILD PARTICIPATED IN FOOTBALL/CHEERLEADING BEFORE (NOT INCLUDING THIS YEAR)? (Y/N) HOW LONG? WHERE? Date of Birth Age as of December 1 (this year) School attending Grade entering Custodial Guardian Guardian Name Relationship Relationship Address Address City/State/Zip City/State/Zip Home Number Home Number Best time to contact Best time to contact Names of adults who have permission to pick up child Names of siblings who also participate in program ********************************************************************************* Medical Information: Doctor Phone ( ) Insurance Company Policy No Subscribers Name Insurance Card Attached Emergency Contact Phone ( ) Relationship Emergency Contact Phone ( ) Relationship I understand as the Participants Legal Guardian I am responsible for any and all medical treatment that is required (Legal Guardian Signature required) Is your child currently taking medication? Yes or No If yes, list and explain Allergies Drug Sensitivities Please read the two statements below and sign under the ONE that you choose. SIGN ONLY ONE. 1. If my child needs medical attention, it is my wish that I be contacted before any medical procedures are taken, unless treatment is necessary to save my child's life or to prevent permanent injury. I accept responsibility for all costs related to such treatment. Parent/Guardian Signature Date 2. If my child needs medical attention, it is my wish that treatment be started while efforts are being made to contact me. So that treatment is not delayed, I consent to any medical procedures that the physician/emt believes are needed, on the understanding that efforts to contact me will continue to be made. I accept responsibility for all costs related to such treatment. Parent/Guardian Signature Date Continued on Back Page
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3 I (print player s name) have read and understand the Roy-Hart LOYAL Football and Cheerleading's Code of Ethics. I will abide by all the rules set forth in this code as well as any directions by the coaching staff and officers of the Roy-Hart LOYAL Football and Cheerleading Organization. Player's Signature Date Parent s Signature Date Coach or Board Member s Signature who received this form Date ************************************************************************************************************ I the undersigned, do hereby swear that I am the legal guardian of the above named child and do hereby grant that the above named child may participate in the NOFA football/cheerleading program and Roy-Hart LOYAL football and cheerleading for the ensuing year/season. I assume all risk and hazards incidental to the conduct of the activities. I do hereby release, absolve, indemnify, and hold harmless Niagara Orleans Football Association (referred to as NOFA), Roy-Hart LOYAL football and cheerleading, the Board, representatives, agents, boosters, sponsors, and supervisors of said organization. This includes any or all of the above stated. Ialso understand as a parent/guardian that I am responsible for all damages incurred by my child while being enrolled in the above stated activities. I further understand that I am financially responsible for any and all equipment and uniforms supplied by Roy-Hart LOYAL football and cheerleading. I will also furnish a copy of a Certificate of Birth for each registered child prior to his/her participation in the program. I am also aware of the Code of Ethics and know that my child and I will read them completely before signing them and returning them to the league. Print Parent/Guardian Name Parent/Guardian Signature Date This section to be completed by Roy-Hart L.O.Y.A.L. Team: Date Amount paid Cash/ Check/ Money Order # Birth certificate: Yes or No or On File Insurance card: Yes or No Physical: Yes or No Person who received this form and payment MAKE CHECKS PAYABLE TO LOYAL ROY HART FOOTBALL RETURN WITH COMPLETED REGISTRATION FORM, PHYSICAL FORM, COPY OF INSURANCE ID CARD, & COPY OF BIRTH CERT. Loyal Roy-Hart Football PO Box 185 Gasport, NY **NO UNIFORMS WILL BE ISSUED WITHOUT BIRTH CERTIFICATE AND FULL REGISTRATION FEES** **ANY CHECK RETURNED FOR INSUFFICIENT FUNDS ARE SUBJECT TO A NSF CHECK FEE PAYABLE IN CASH ONLY**
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5 Roy-Hart LOYAL Football & Cheerleading Consent/Liability Form I, the undersigned parent/guardian of who has been registered to participate in the football/cheerleading program sponsored by the Roy-Hart LOYAL, hereby give permission formy son/daughter to participate in any and all activities of Roy-Hart LOYAL related to their sport. I understand that injuries may occur in the sport, and I hereby waive, release, and agree to hold harmless Roy-Hart LOYAL, it s officers, directors, and others associated with it in any way, as well as other participants and their parents/ guardians, from any claim arising out of an injury to my child. Initial here Furthermore, I agree to return upon request, any equipment issued to my child by Roy-Hart LOYAL in as good of condition as when it was received, except for normal wear, or otherwise to pay Roy-Hart LOYAL the cost of replacing any portion of the uniform or equipment I do not return. Initial here I acknowledge that the LOYAL Roy-Hart Football and Cheerleading organization has provided me with a rule book on their website, and it is my responsibility as a parent to follow the rules outlined in the rule book and make my child aware of these rules. I understand that it is my responsibility to read the rules and have my child read these rules at our discretion. Failure to comply with these rules may result in adverse actions to my involvement with the LOYAL Roy-Hart Football and Cheerleading organization up to and including future suspension from the league. Initial here I consent to have the above named child participate in any mandatory fundraising events. If fundraising requirements are not met and payment is not made by the last practice preceding the first game, participant will not be able to participate until the obligation is met. Initial here I agree to allow individual and team pictures taken of my child through LOYAL to be posted on LOYAL website or LOYAL Football and Cheerleading Group Page. (Please note pictures taken of players/cheerleaders, other than your own, cannot be posted on your personal web pages, Facebook, etc.) Initial here I acknowledge that this is a volunteer organization and that I am required to volunteer twice (2) per child registered up to a maximum of four (4) times per season. I understand that once I commit to a volunteer activity I am responsible for showing up on time and performing that activity. Initial here Date Parent/Guardian Signature Print Parent/Guardian Name Phone # ( ) Date Board Member Signature
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7 Roy-Hart LOYAL Football/Cheerleading Player-Parent-Coach Code of Conduct It is the goal of Roy-Hart LOYAL Football and Cheerleading to provide every child with an opportunity to play a sport that they love and to have competitive fun in the process. Below is the code of conduct that will be expected for all players, parents, and coaches. PLAYERS - FOOTBALL AND CHEERLEADING: Initial here I will remember that I am here to learn and have fun. I will learn the rules of the game and what is expected of me during practice and games. I will be at all practices and games on time and will be prepared. If I cannot make it I will call my coach before the practice or game begins. I will show respect, courtesy, and demonstrate positive support for all players, coaches, officials and spectators at every game, practice, or other sporting event. I will not engage in any kind of un-sportsmanlike conduct with any official, player, coach, or parent such as booing or taunting; refusing to shake hands; or using profane language or gestures. I will inform my coach of any injury or ailment that makes it difficult for me to participate. I will give 100% during practice, at games, and in school. I also agree that if I fail to abide by the aforementioned rules, I will be subject to disciplinary actions that could include, but is not limited to any one of the following: Verbal warning by coaches. Notice to parents Game suspension Season suspension from league for remainder of current season PARENTS/GUESTS OF PLAYERS: Initial here I will remember that all children participate to learn and have fun. I will learn the rules of the game and what is expected of my child during practice and games. I will make arrangements so that my child is at all practices and games on time and prepared. If my child cannot make it I will call the coach before the practice or game begins. I (and my guests) will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy and by demonstrating positive support for all players, coaches, officials, and spectators at every practice, game, or other sporting event. I will not engage in any un-sportsmanlike conduct with any official, coach, player, or parent such as booing, taunting, using profane language or gestures, or creating disturbances by verbal or physical altercations. I will inform my child s coach of any injury or ailment that makes it difficult for my child to participate. I will never ridicule or yell at my child, other players, coaches, or officials for making a mistake or losing a competition. I will refrain from coaching my child or other players during games and practices unless I am an official coach or have been asked to assist on a specific task by the head coach. I will immediately bring forth any issue of concern to the appropriate official of the organization and will assist in maintaining a positive and nurturing environment for the sake of our children. I also agree that if I fail to abide by the aforementioned rules, I will be subject to disciplinary actions that could include, but is not limited to any one of the following: Verbal warning by LOYAL Football and Cheerleading Board. Meeting with LOYAL Board to discuss possible sanctions based on extent of violation or infraction. Game suspension. Season suspension from league for remainder of current season. Permanent suspension from the league.
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9 PLAYER S SIGNATURE PARENT S SIGNATURE COMMISSIONER S SIGNATURE DATE DATE DATE
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11 ROY-HART LOYAL FOOTBALL AND CHEERLEADING VOLUNTEER SIGN-UP FORM I would like to volunteer in the following way (2 volunteer opportunities per child up to a maximum of 4 volunteer opportunities per season CONCESSION STAND (Parent Participation Coordinator will contact you for scheduling) DANCE (Parent Participation Coordinator will contact you for scheduling Limited Availability) CHAIN GANG ANNOUNCER TIME CLOCK KEEPER PARENT REPS (TEAM PARENT) **See your child s coach** COACH / ASSISTANT COACH (Head Coaching positions require an official letter of intent submitted to the LOYAL Roy-Hart Board prior to any coaching decision being made - Assistant Coaching positions are available at the sole discretion of the Head Coach) Football OR Cheerleading Beginner Mini JV Varsity Child s Name Child s Team / Level Football ~ OR ~ Cheerleading / Beginner Mini JV Varsity Volunteer Name Phone Number Game Preference: Beginner Mini JV Varsity Thank you in advance for your time and help. We appreciate it! Sincerely, The Board of Directors Roy-Hart LOYAL Football and Cheerleading
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