JR.

RAMS FOOTBALL REGISTRATION/EMERGENCY INFORMATION & CONSENT FORM

4844 Sycamore, Holt, MI 48842
Jr.RamsFootball@ameritech.net
Date:

____________

FALL GRADE:

_______

School:

______________________________

Athletes Full Name: __________________________________________________________________

Last
First
Middle
Address: ______________________________________________________________________________
Street
City
Zip Code
D.O.B._______________________

HEIGHT_______________

WEIGHT_______________

Fathers Name: ________________________________________________________________________

Address: ______________________________________________________________________________
Employer: _____________________________________________________________________________
Home Phone:(_______)________________

Cell Phone:(________)_________________

Work Phone: (____) ______________ Email________________________________________________

Mothers Name: ________________________________________________________________________
Address: ______________________________________________________________________________
Employer: _____________________________________________________________________________
Home Phone:(_______)________________

Cell Phone:(________)_________________

Work Phone: (____) ______________ Email________________________________________________

Family Medical Insurance:
Carrier: __________________________________ Group: ____________________________________
Policy #:_________________________________ Group#:_____________________________________
Family Physicians Name:_______________________________________________________________
Physicians Address:___________________________________________________________________
Physicians Phone:(_____)___________________ Email: ___________________________________
Allergies (list):______________________________________________________________________
Serious Medical Conditions (list):_____________________________________________________
I/we hereby grant consent to any and all health care providers designated by Tri-County
Youth Sports Administrators, officials, or coaches to provide my child
_________________________ any necessary medical care as a result of any injury/illness.
(Name)
This consent includes First Aid and transportation to/from health care providers.
_________________________________________
Fathers Signature
_________________________________________
Mothers Signature
VOLUNTEER:

EQUIPMENT HANDOUT

________________
Date
________________
Date

CONCESSION STAND

LAUNDRY

Jr. Rams is run entirely on a volunteer basis. Parents/guardians are asked to donate their time.
circle any of the above you are able to help with. Thank you for your support!

Please

JR.RAMS FOOTBALL
4844 Sycamore, Holt, MI 48842
Jr.RamsFootball@ameritech.net
TRI-COUNTY YOUTH SPORTS WAIVER/RELEASE FORM
PLEASE READ BEFORE SIGNING
IN CONSIDERATION OF: ___________________________________, my child/ward, being
Name of Minor Child/Ward
Allowed to participate in any way in the Tri-County Youth Sports related events and activities, the undersigned
acknowledges, appreciates, and agrees that: The risk of injury to my child from the activities involved in these
programs is significant, including the potential for permanent disability and death, and while particular rules,
equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
1) FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both
known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE PARTICIPANTS, spectators or,
administrators, other, and assume full responsibility for my childs participation; and
2) I willingly agree to comply with the programs stated and customary terms and conditions for participation. If I
observe any unusual significant concern in my childs readiness for participation and/or in the program itself, I will
remove my child from the participation and bring such attention of the nearest official immediately; and,
3) I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representative and next of kin,
HERBY INDEMIFY, release and hold harmless Tri-County Youth Sports; its directors, officials, agents, employees,
volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of
premises used to conduct the event, WITH RESPECT TO ANY AND ALL LIABILITIES INCIDENTS, INJURY,
DISABILITY, DEATH, or loss or damage to person or property incident to my or my childs/wards involvement or
participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR
OTHERWISE, to the fullest extent permitted by law.
II HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING
IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
____________________________________________
(PARENT/GUARDIAN SIGNATURE)
____________________________________________
(PRINTED NAME OF PARENT/GUARDIAN)
____________________________________________
Date Signed
UNDERSTANDING OF RISK
I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for
adhering to rules and regulations, and accept them as a participant.
____________________________________________
(PARTICIPANT SIGNATURE)
____________________________________________
(PRINTED NAME OF PARTICIPANT)
____________________________________________
Date Signed