Player's Name  

Male  Female

Date of Birth January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1996 1997 1998 1999 2000 2001 2002 2003 2004    Player's Age on May 1, 2009

Player's School      Current Grade in School   

Is the Player covered by group medical insurance? Yes    No

Street Address
NV CA

Email Address

Home Phone    Parent Work or Cell Phone #

Emergency Contact Name Phone Relation

Does the Player have any medical conditions or special limitation? Yes  No    If yes, please explain

Parent or Legal Guardian Name

Please list any siblings registered  

The questions below will assist with putting together equal and fair teams.  Please answer as completely as possible.  Please note that rosters are kept to a minimum so that all players will receive substantial playing time.

Has the Player participated in the Carson City Youth Flag Football League before?  Yes  No

What other sports programs has the player participated in?  List programs and how long.
        Program                                                    Years

Has the Player been recognized as an All Star in any other Program?
Yes  No    If yes, how many years and which sport?

Player's Height Weight                Preferred Position

Jersey Size  Youth S Youth M Youth L Youth XL             Jersey Number Request:      1st Choice     2nd Choice 

Notes: Please list any special requests or needs here.

Waiver of Liability and Release

In return for my child ("player") being allowed to participate in The Carson City Youth Flag Football League Program, (The Program"), I release and agree not to sue The Carson City Flag Football League, it's members and their sub-contractors, sponsors, agents, and affiliates from all present and future claims that may be made by the player or me, my family, estate, heirs, or assigns for property damage, personal injury or wrongful death arising as a result of Player's participation in the program and caused by the ordinary negligence of the parties listed above, wherever, whenever, or however the same may occur. I understand and agree that those listed above are not responsible for any injury or property damage arising out of the Program, even if caused by their ordinary negligence. I understand that participation in the Program involves certain risks, including, but not limited to , serious injury. I am voluntarily allowing Player to participated in the program with knowledge of the danger involved and agree to accept all risks of such participation. I certify that the Player is in excellent physical health, and may participate in strenuous and hazardous physical activity, including the football to be played in the Program. Permission is granted for Player to receive emergency medical treatment, if needed. I also agree to indemnify and hold harmless those listed above for all claims arising out of Player's participation in the Program and all related activities. I agree to let the parties use Player's name and likeness free of charge in any manner and for any purpose without compensation to me or Player. I understand that this document is intended to be as broad and inclusive as permitted by the laws of the State of Nevada and agree that if any portion of this agreement is invalid, the remainder will continue in legal force and effect. By entering my initials in the accept box below, I am verifying that I am the parent or legal guardian of the player. I am of legal age and am freely agreeing to the terms of this waiver. I have read this form and understand that by initialing the accept box below, I am giving up legal rights and remedies. I agree that the terms of this release are binding on me and the child. I am submitting with this form my child's registration fee for the program and I am aware that the registration fee is non-refundable.

After reading the Waiver of Liability and Release thoroughly, do you accept the terms?

Yes.  I have read and understand the Waiver of Liability and Release and I accept the terms by entering my initials in the box provided.

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