Player Cheerleader Mid-State Youth Football & Cheerleading Conference OFFICIAL APPLICATION TO PARTICIPATE Please Print No. Registration Date Age Sept 1st Sign Up Weight Name LAST NAME FIRST NAME MIDDLES INITIAL Birth Date Address School STREET CITY ZIP Phone Next Grade Prior Participation? No Yes If yes, how many years Father s Name Address Phone Mother s Name Address Phone Primary E-Mail Address Health Insurance Carrier MEDICAL HISTORY Yes No Yes No Yes No Asthma Fractures within past year Head injuries within past year Allergies Dental braces or bridges Serious illness Glasses/Contacts I/We the parent(s) of the above named candidate for position on a Mid-State Conference team, hereby give my/our approval to our child s participation in any and all activities during the current season. I/We assume all risks and hazards incidental to such participation, including transportation to and from the activities: and I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the local League, the organizers, sponsors, supervisors, participates and persons transporting my/our child, 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 candidate upon request to the league officials. I/We agree to be financially responsible for League equipment my/our child will receive other than the normal wear and breakage during games and practice and I/We will reimburse the League for the loss and damage to said equipment. I/We give permission for League to validate participant s school grades. Father s Signature Father s Occupation Mother s Signature (One Signature Mandatory) Mother s Occupation EMERGENCY MEDICAL RELEASE I/We the parents give our permission for any emergency medical 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 function including the supervised travel to and from said function. Father s Signature Mother s Signature (One Signature Mandatory) REGISTRATION CERTIFICATION ASSIGNMENT APPROVAL BY AUTHORIZED OFFICIAL Sizes Squad (Circle One) Birth Certificate Physical Exam Shoulder Pad Helmet Pants Jr. Pee Wee Peewee YES, I WOULD LIKE TO VOLUNTEER TO HELP WITH: Coaching Team Assistant Equipment Dist. Fundraising Chain Gang Play Counter Picture Day Game Field Setup Concessions Other Registration $ Equipment Deposit $ Other $ FOR ASSOCIATION USE PAYMENTS Signature Signature Signature Do you have a sibling participating in program? Yes No Warning: Injury may result from playing football or cheerleading.
MID-STATE YOUTH FOOTBALL & CHEERLEADING CONFERENCE 2018 EMERGENCY CONTACT & PARENTAL RELEASE and UNDERSTANDING FORM (PRINT OR TYPE) 1) This Emergency Contact & Parental Release and Understanding for must be dated, signed and submitted prior to the first practice at the start of the 2018 season. (August 1, 2018) 2) No players or cheerleaders will be allowed to participate in any Mid-State Youth Football & Cheerleading Conference activities until this form is completed and on file. 3) This form once completed will be kept with each teams medical kit in the event that an emergency situation should arise. CHILD S NAME ADDRESS (Last) (First) (Middle Initial) CITY PHONE HEALTH INSURANCE CARRIER STATE ZIP KNOWN ALLERGIES MEDICATION(S) EMERGENCY PHONE NUMBERS IN THE EVENT THAT I/WE NEED TO BE REACHED DURING EITHER PRACTICE OR A GAME, YOU MAY REACH ME/US OR THE FOLLOWING AT: (PLEASE LIST (4) INCLUDING YOURSELF) NAME PHONE # STATEMENT OF PARENTAL RELEASE AND UNDERSTANDING We the parent(s)/guardian(s) for the above named participant hereby give my/our approval for our child s participation in any or all activities during the current season. I/We understand and agree to the following items: 1. That the above named is physically fit to play in accordance with the Physical Form we have on file. 2. That I/We assume all risks and hazards incidental to such participation, including transportation to and from any and all activities. I/We understand that injuries may result from playing football or cheerleading. The coaching staff reserves the right, after consultation with the parent(s)/guardian(s), to withhold from further participation in either practice or game any child that they feel is no longer fit to participate. 3. I/We agree to be financially responsible for the equipment my/our child has been issued. I/We will reimburse the Mid- State Conference and/or local league that issued the equipment for the loss of and/or damage to said equipment beyond normal wear and breakage. 4. Mid-State Conference and/or local league reserves the right to discipline any of its participants for conduct that is considered inappropriate or detrimental to the program. If such an instance should occur, a conference shall be held with you the parent/guardian and all other parties involved to determine what measures shall be taken including suspension from any/or all further activities. THE THROWING OF EQUIPMENT SHALL NOT BE TOLERATED. EMERGENCY MEDICAL RELEASE I/We the parent(s)/guardian(s) give our permission for any emergency medical treatment either on the practice or game field. I/We authorize any emergency personnel, hospital and/or physician to perform emergency treatment for any injuries resulting from any scheduled function including the supervised travel to and from said function. I/We agree to be financially responsible through either our health insurance carrier or by another means for any costs incurred due to the providing of emergency medical treatment. PARENT/GUARDIAN S SIGNATURE DATE _
Sportsmanship Agreement Rosholt Area Youth Football (RAYF) was formed under Mid-State Youth Football & Cheerleading Conference (MSYFCC) with the intent of offering a positive experience. Under this premise, athlete participation, sportsmanship, and the overall importance of a positive athletic experience take precedence over winning. Representatives of MSYFCC & RAYF including, but not limited to, MSYFCC & RAYF board of directors, and game officials have total control of and complete authority over all competition. All decisions made by theses persons are final and have full support of MSYFCC & RAYF. These representatives are commissioned by MSYFCC & RAYF to take action deemed necessary to guarantee a positive atmosphere for competition. To help ensure a positive atmosphere, athletes, coaches and spectators are expected to do the following: Stand during the National Anthem Maintain self-control at all times Show respect for opponents Support your team in a positive manner Recognize and acknowledge good performance by all teams and individuals Be humble in victory and gracious in defeat Unsportsmanlike conduct, on the part of players, coaches, managers or spectators will not be tolerated and may result without warning in expulsion (team and/or individual) from MSYFCC & RAYF. Unsportsmanlike conduct includes, but is not limited to, the following: fighting, trash talking, taunting, foul language, and verbal abuse/intimidation of opponents, game officials and/or representatives of MSYFCC & RAYF. No individual or team refunds will be given if expulsion occurs. It is expected that athletes, coaches, and spectators exercise total cooperation with these representatives at all times. Players who violate the terms of this agreement will, at the discretion of the coach, and the Rosholt Area Youth Football board, be suspended: First offense Warning Second offense One game suspension Third offense The season is over (Parent s name) (Participant s Name) (Parent s Signature) (Participant s Signature) Date:
Participation Agreement Team Roster & Photo Release Consent I DO give Rosholt Area Youth Football & Cheerleading permission to publish information to be distributed in team rosters for the parents of players on my child(ren) s team(s). OR I DO NOT give Rosholt Area Youth Football & Cheerleading permission for information to be published in team rosters for the parents. ----------------------------------------------------------------------------------------------------------------------------------------- I DO give consent to Rosholt Area Youth Football & Cheerleading to use my child s picture(s) in published promotional materials. OR I DO NOT give consent to Rosholt Area Youth Football & Cheerleading to use my child s picture(s) in published promotional materials. Initials Volunteer & Fund Raising Committees and Policy We require volunteer time (6 hrs) and participation in all fund raising activity per family, per season. I choose to fulfill the volunteer obligations: I understand I will pay a $50.00 volunteer fee (per family) at the time of registration. This fee will be returned to me at the End of the Year Banquet if I have fulfilled my volunteer obligations. If I have not fulfilled my volunteer obligations I will forfeit this $50.00. OR I choose to opt- out of the volunteer obligations: In exchange for the $50.00 fee due at registration. Initials Payment and Refund Policy THERE WILL BE NO REGISTRATION REFUNDS ISSUED AFTER MAY 1, 2018 FOOTBALL The registration fees for the 2018 season are as follows: $125.00 + $50.00 (volunteer fee per family) = $175.00 (Total) for NEW or Returning player needing a NEW JERSEY $100.00 + $50.00 (volunteer fee per family) = $150.00 (Total) for Returning player NOT needing the JERSEY. Payment is due at the time of registration. No child will be turned away for this program due to a legitimate financial reason, please apply for assistance. Determinations are based on need. Request must be made in writing and must be received at time of registration.
CHEERLEADING The registration fees for the 2018 season are as follows: $100.00 + $50.00 (volunteer fee per family) = $150.00 (Total) Payment is due at the time of registration. No child will be turned away for this program due to a legitimate financial reason, please apply for assistance. Determinations are based on need. Request must be made in writing and must be received at time of registration. Initials Concussion Safety Bill Passed On April 2, 2012, Governor Scott Walker signed into law Assembly Bill 259, the Concussion Safety Bill. The law mandates that parents of student athletes, younger than age 19, be provided with written material describing symptoms of concussions. In addition, the law requires that athletes who suffer a suspected head injury in either practice or a game be immediately removed and not allowed to resume playing without the written clearance of a health care provider who has examined them. A "health care provider" is defined as a physician, a physician's assistant licensed under ch. 448, an advanced practice nurse prescriber certified under s. 441.16 or an athletic trainer licensed under subch. VI of ch. 448 I have received the Centers for Disease Control and Prevention publications: 1. Concussion in Sports 2. Heads Up Concussion in Youth Sports, A Fact Sheet for Athletes 3. Heads Up Concussion in Youth Sports, A Fact Sheet for Parents I understand and agree that if my child is suspected of suffering a head injury in either a game or practice, my child will be removed from play and will not return until RAYF has received written clearance from a health care provider. Initials Participation of Football Players Policy There may be no more than 10 hours per week of practice before Labor Day and no more than 6 hours per week after Labor Day. Weekly practice of 2 hours per day (Monday-Friday). Days missed due to voluntary actions (i.e. vacations), will be dealt with individually by head coach. Days 1 & 2 Helmets and mouth guards only Days 3 thru 5 Helmets, mouth guards and shoulder pads only Days 6 & after Full equipment Week 1 ONLY Drill Contact (Air, Bags & Wrap) is allowed and it s unlimited. Competition/Full Contact is NOT allowed. Week 2 - Drill Contact (Air, Bags & Wrap) is unlimited. Competition/Full Contact is limited to 75 minutes per week (excluding a scrimmage) Week 3 & beyond - Drill Contact (Air, Bags & Wrap) is unlimited. Competition/Full Contact is limited to 60 minutes per week (excluding games) After Labor Day weekend, regular practice schedule will consist of 2 hours per day (Tuesday and Thursday) and walk through on Fridays for one hour. Dates and times may change due to weather. Participation of Cheerleading Policy There may be no more than 10 hours per week of practice before Labor Day and no more than 6 hours per week after Labor Day. Weekly practice of 2 hours per day (Monday-Friday). Days missed due to voluntary actions (i.e. vacations), will be dealt with individually by head coach. No stunting, tumbling, or competition practice is allowed in the first ten hours of cheer practice. Completion of ten hours of practice is mandatory before a cheerleader may participate in preseason or season games.
General Policy Participation in fundraising activities is required Participants will arrive ON TIME to all practices, games, and RAYF special events. Tardiness to practice will be handled by the Head Coach of his/her team. If a player is absent from practice WITHOUT contacting the coach with a valid reason prior to the schedule practice start time, that player will be ineligible to participate one half of the next scheduled competition/game. If a player is absent from two or more practices prior to the next schedule competition/game, that player will be ineligible to participate in its entirety from the next scheduled competition/game. Absenteeism excuses will be discussed and determined valid by the entire coaching staff for their respective teams. Initials I have read and agree to the above POLICIES and I understand the terms as stated & checked: Parent/Guardian Signature: Date: