Upland Hurricanes Jr. All American Youth Football and Cheer Participants Name Age (as of 7/31/15): Weight: PROGRAM Tackle Football Cheer Flag Football DIVISION Jr. Micro Jr. Pee Wee Midget Micro Pee Wee REQUIRED DOCUMENTATION 2015 Player Contract Copy of Birth Certificate Section IV Completed by A.D. Copy of Utility Bill 2015 Members Code of Conduct Copy of Report Card Upland Hurricanes Season Rules Player's Waiver (if applicable) Physical Examination PAYMENT Self Chapter Tackle Cheer Flag Full Payment Sponsorship Deposit 2015 Registration Fee - $220 / $220 / $140 $ cash / check / credit * includes $40 snack bar ($20 reimbursable upon working two 2 1/2 hour shifts) 2015 Chapter Fundraiser - $150/$100 (Flag) Buyout Fundraiser Sponsorship FOOTBALL EQUIPMENT / UNIFORM Measurement - Inches Sizing Helmet (measure 1" above eyebrows) = Circumference of Head XS S M L XL Shoulder Pads (measure upper torso, contour of shoulders) = Chest = Shoulders S M L XL 2XL Jersey Pants Spirit Pack - Jersey Spirit Pack - Shorts Email: Miscellaneous Information: Youth Adult @ Verification Completed By:
SOUTHERN CALIFORNIA JUNIOR ALL AMERICAN CONFERENCE, INC. 2015 PLAYER'S SEASON CONTRACT (PLEASE READ CAREFULLY) Rev. 3/12 SECTION I SCJAAFC Chapter Team Name _ DIVISION: JR. MICRO MICRO JR. PEE WEE PEE WEE MIDGET CHEERLEADING RETURNING NEW SECTION II TO BE COMPLETED BY CANDIDATE PLAYER & PARENTS NO CANDIDATE will be permitted to participate in any activity until SECTIONS II, III, V and VII of this Contract has been completed in full. The CANDIDATE PLAYER agrees that he will faithfully abide by the Rules of the SCJAAFC to the very best of his ability. Last Name First Middle Birth date Age School & grade Address City Zip Home phone number Cell number Parent/Guardian Cell number Parent/Guardian Email address SECTION III EQUIPMENT RESPONSIBILITY I/We as parent/guardian of said candidate do hereby assume full and complete for the proper care and maintenance of all equipment loaned by Local Chapter to said candidate. I understand all equipment is to be used for SCJAAFC activities only and that all equipment remains the legal property of Local Chapter. I agree to reimburse Local Chapter for any and all equipment that is lost, damaged or stolen for the full replacement cost of said equipment, with payment due when equipment is requested by Local Chapter, or immediately upon the withdrawal of said candidate from Local Chapter. RULES AND REGULATION I/We as parent/guardian of said candidate understand it is the responsibility of the parent/guardian, candidate, team and chapter to comply with any and all rules and regulations of SCJAAFC. Any noncompliance with rules and regulations shall be cause for disciplinary action to be taken against said candidate, parent/guardian, team or chapter by SCJAAFC. PARENT/GUARDIAN: Signature Print Name Date RELATIONSHIP TO MINOR: FATHER MOTHER LEGAL GUARDIAN SECTION IV PROOF OF AGE (to be completed by Athletic Director) FULL Legal Name: Birth date (No Nicknames) (Please print!) (Month, Day, Year) Proof of Age: Birth Cert Abstract Gov t ID Record of foreign birth School Record SECTION V MEDICAL EXAMINATION (BY QUALIFIED DOCTOR OF MEDICINE) Height Weight Blood Pr. Heart Ears Nose Teeth Abdomen Extremities Hernia (recommended) REMARKS: ( ) While this examination does not constitute a complete Medical Examination, it does on this date, and based upon my observation, meet the requirement for participation in this youth football program. ( ) Individual examined by me this date is considered not physically qualified to participate in this youth football program for the following Reasons: _ Examining Dr. _ Office Phone Date SECTION VI FOR RESPONSIBLE CHAPTER AND TEAM OFFICIALS ONLY In approving the above Candidate's Player Season Contract, we hereby certify that the Birth Certificate submitted does correspond with the name and birth date shown in Sections II and IV. In addition, we hereby certify that the Parental Consent and Medical Treatment Authorizations, Section Ill, was completed, and, together with the Medical Examination, Section V, was completed by the qualified Doctor of Medicine listed, prior to the Candidate's participation in any manner with this team. We certify that we have explained fully the procedures to follow in the event of injury, and that in- jury/insurance reporting must be performed in accordance with SCJAAFC rules and procedures. Finally, we certify that a copy of the Player Season Contract was furnished to the Parent(s) or Guardian, as applicable. Responsible Chapter Official Date Signed Certification Official Date Signed
YOUTH TACKLE CONFERENCE OF SOUTHERN CALIFORNIA 2015 Upland Hurricanes Member s Code of Conduct In accordance with the Youth Tackle Conference of Southern California (dba) Southern California Junior All American Football Conference (SCJAAFC) each participating member and parent must sign this Code of Conduct before being certified for participation. I/We will not for any reason go on to the football field during practice and/or games unless summoned by the Head Coach or Team Athletic Director. I/We will not use profanity, tobacco products or alcoholic beverages at any practice or game field in accordance with the SCJAAFC Conference rulebook. Violation of this rule can result in suspension from the league for my family including my child. I/We will not approach or berate any game officials, league officials and/or conference/chapter board members. Violation of this rule can result in suspension from the league for my family including my child. I/We agree to abide by the 24-hour cool down period prior to discussing concerns with my child s coaches after a game. I/We understand that fighting is not tolerated and will result in immediate suspension or termination from the league. I/We agree that the Upland Hurricanes football program is for the kids and should be free of adult ambition. Local Authorities will be contacted and apprised of any threats of physical harm against children or adults, which can lead to arrest and/or prosecution. The Youth tackle Conference of Southern California, Inc. (dba) Southern California Junior All American Football Conference (SCJAAFC) has adopted a zero tolerance rule in handling behavior issues for this season. Any participant in SCJAAFC can be banned from participation in football or cheer if they or their parents/guardians demonstrate any disruptive behavior. Both the football player and parent/legal guardian prior to participation in an SCJAAFC football game must sign this document. Player Signature Parent Signature Date Team Division
S.C.J.A.A.F Medical Examination From Season 20 2015 This form satisfies Section IV of Player s Season Contract. This form MUST be completed by a qualified Doctor of Medicine, Doctor of Osteopathy, Nurse Practitioner or Physician s Assistant as described in rules, Article III, Section C, and Certification #2.) J.A.A.F.S.C. Chapter Team Name Last Name First Name Middle Birth Date Age Phone Address City, State Zip code Height Weight Blood Pressure Heart Ears Nose Teeth Abdomen Extremities Hernia (recommended, NOT REQUIRED) Remarks: ( ) While this examination does not constitute a complete Medical Examination, it does on this date, and based upon my observations, meet the requirements for participation in this youth football program. ( ) Individual examined by me on this date is considered not physically qualified to participate in this youth football program for the following reasons: Explanation Examining Dr. Office Phone Signature Stamp required Date: Date Actual Physical performed: