Gilberts Youth Football Cheerleading Association P.O Box 58 Gilberts, IL 60136Page1of5

ParticipantInformation

FOOTBALLCHEERLEADING

ParticipantName:
(Asifappearsonbirthcertificate) / DateofBirth:
Address: / City:
State: / ZipCode:
HomePhone#: / Weight:
YearsinTackle/Cheer: / Gradeasof9/1/13:
School: / Ageasof9/1/13:
How didyouhearaboutus?
Jersey#Preferences: / 1)2)3)

EmergencyMedicalInformation

EmergencyContactName: / Phone#:
Relationship:
DoctorName: / DoctorPhone#:
MedicalConditions:

Parent/GuardianInformation

Mother’sName:
Address: / City:
State: / ZipCode:
Phone#: / Cell#:
WorkPhone#: / EmailAddress:
DateofBirth: / (Month/Year) / CustodialParent: / YESNO
IwouldlikeGYFCA Informationemailedtome: / YESNO
Father’sName:
Address: / City:
State: / ZipCode:
Phone#: / Cell#:
WorkPhone#: / EmailAddress:
DateofBirth: / (Month/Year) / CustodialParent: / YESNO
IwouldlikeGYFCA Informationemailedtome: / YESNO
What is the best number for the family to be reached at by the organization/coach?

ForAdministrativeUseOnly(TobecompletedbyGYFCASTAFF)

RegistrationPayment

BirthCertificate

Gilberts Youth Football Cheerleading Association P.O Box 58 Gilberts, IL 60136Page1of5

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Agreements,WaiversAuthorizations

Initials / Football Waiver
We do hereby for ourselves, our heirs, executors and administrators waive, and forever discharge any and all rights and claims for damages which we may hereafter accrue to our child, against Gilberts Youth Football and Cheerleading Association, and sponsors, the administrators of the playing field, or all their respective officers, agents or representatives, successors, and/or assigns for any and all damages which may be sustained and suffered by our child in connection with his/her said association with or entry and/or arising out of his/her traveling to and participation in and return from said league games of exhibitions conducted during the season. By our initializing to the left, we (the parents) are fully aware that we are responsible for all injuries that may occur to our child during Gilberts Youth Football and Cheerleading Association seasonal campaign (other than the league insurance coverage). We hereby acknowledge that the league does not require a thorough physical exam prior to participation.
Initials / Parental Medical Treatment Agreement
I, the Custodial Parent/Legal Guardian, give the staff of the Gilberts Youth Football and Cheerleading Association permission to administer appropriate emergency medical attention to my child in the event of any accident, illness, or injury which may occur during any scheduled GYFCA function including the supervised travel to and from said functions. I also authorize any hospital, paramedic, and or physician to administer appropriate emergency medical attention for any accident, illness or injury which occurs at any scheduled GYFCA function including the supervised travel to and from said functions.
Initials / Medical Information
Does the participant have any serious injury, illness, allergies or Medical condition that would prohibit participation in GYFCA activities?
NOYES Explain ______

Policies

Initials / Registration Fee
GYFCA does not offer refunds for football or cheer registration fees after the first day of mini camp.
Initials / Grievance
If any parent or participant has a concern or complaint the following procedure must be followed:

1. Talk to the Head Coach of the team your child plays football or cheers for.
2. Communicate the issue with Football/Cheer Commissioner.

3. If the parent is still not satisfied the Operations Vice-President should be contacted:
4. If at this time the parent feels the concern still has not been corrected, the concern will be brought before the GYFCA Grieveance Committee for further investigation and their decision will be final.
The Gilberts Grizzlies logo design, artwork, and personal information about our players and families, including e-mail addresses are intellectual property of the copyright and/or trademark of GYFCA. Use of the logo is considered infringement of the copyright and/or trademark. You must obtain expressed written permission from GYFCA for any logo/artwork usage. .Anyone caught using our logos, art work, or e-mail addresses without written permission will be responsible for all fines, fees, court costs, fines, and attorney fees.

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ConsentsLegalProvisions

______
Initials / I, the Parent/Guardian, agree to be financially responsible for the GYFCAequipment.GYFCA requires a $230.00 deposit for Football and Cheer equipment. For Football it includes; helmet, shoulder pads, home game jersey, and home game pants. For Cheer it includes: skirt and top. Deposit will be returned once ALL equipment is returned in clean condition and in like new condition without excessive wear and tear on a specific date for the 2013 season. Should equipment not be returned on that date, your equipment deposit check will be cashed immediately. Should you return your equipment after the scheduled date, a 100.00 administration fee will be deducted from the deposit check that was cashed. In the event that arrangements are not made to return equipment before the scheduled return date and the equipment is not returned on the scheduled date, a police report will be filed and you will be responsible for all court costs, fines, bank fees, and attorney fees associated with getting the equipment back to GYFCA.
____
Initials / I, the Parent/Guardian, understand that my child’s specific level of participation will be determined by GYFCA based on the child’s safety, performance through coaches’ evaluations, and the best interest of the child. Parents will not infringe on that process.
______
Initials / I, the Parent/Guardian, agree to attend the Parent Meeting (prior to my child’s participation) and abide by the GYFCA Parents Code of Ethics and all other GYFCA policies.
______
Initials / I, the Parent/Guardian, agree to participate in a minimum of $100 in fundraising for the playing season for each family registered. Each participant will receive 10 value cards to use at local establishments in the area for 2013. Should you want more cards for friends and family, they will be available for 10.00 per additional card.
____
Initials / A parent volunteer deposit fee of $100.00 is required at registration. As a volunteer organization, we rely on you to help the organization. Each family will be required to volunteer 15 hours of their time during the football season. Volunteering can occur at home games and other GYFCA sanctioned events. Deposit checks will be returned at the end of the season if you have completed your 15 hours of service per family. Each parent will be required to sign up for an assignment at registration oryouwill be assigned to a specific duty for a specific game/event basedon the needs of the organization. If you fail toshow up for any of your required assignments for your specific time/date, your deposit check will be cashed immediately.
___
Initials / I hereby give permission to GYFCA to take photos of my participant to be used for publicity release or the website.
______
Initials / I hereby give permission for my house to be toilet papered during homecoming activities.
______
Initials / Expenses that will be incurred for football include: Cleats, white practice pants, 7 piece pad set, orange game socks, orange mouth guard, chin strap, practice jersey, athletic supporter, and rib pads. Practice pants MUST be white. Gamesocks and mouth guard MUST be orange. Mouth Guards, Socks, Practice Jerseys, and Chin Straps are available for purchase. Kids will not be allowed to practice or play unless they are in the proper attire.
be allowed to practice ir play without required and proper attire.
_____
Initials / GYFCA will provide each cheerleader with a uniform that will include a skirt and top. These items must be returned clean and in good condition at the end of the season. GYFCA requires the following items to be identical and all are included in the Cheer Package: Bodysuit, briefs, hair bows, socks, and shoes. These items are included in the registration fee. One competition fee is included in the registration fee. All other competitions will not be covered by GYFCA and will be paid for through parents or fundraising by the cheerleaders.
______
Initials / Prior to being assigned to a team, receiving any equipment, or attending practices, the following completed documents MUST be provided to GYFCA. Failure to provide these documents will result in no practice time and possible dismissal from the program. All documents MUST be received by the July 22,2013.

• Proof of age in the following form: Copy of certified Birth Certificate (NO hospital certificates)
• Completed Waiver, signed by parent or guardian

______
Initials / I the Parent/Guardian understand that GYFCA highly stresses the importance of academic performance and my child will maintain a “C” (2.0) or above average.
I the Parent/Guardian understand that football and cheer will have a volunteer mini-camp from July 22-24 for a fee of $20.00. This will include a Grizzly tee shirt for all paid attendees..

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ParentCodeofEthics

Allparentswillabidebythecodeofethicswhichincludesthefollowing:

1. I will require that my child’s coach be ASEP trained in the responsibilities of being a football coach and that the coach upholds the code of ethics for coaches.
2. I will encourage good sportsmanship by demonstrating positive support for all participants, coaches, officials, board members, and staff at any league sponsored vent at home or way.
3. I will encourage a balanced lifestyle between sport, education, and other interests.
4. I will place the emotional, psychological, and physical well being of my child and any other child in the league ahead of any personal desires I may have.
5. I will insist that my child participants in a safe, fun, and healthy environment.
6. I will support all coaches, board members and others working with my child to encourage a positive and enjoyable experience for all.
7. I will accept that striving to win is more important than winning.
8. I will remember that GYFCA is for the youth and NOT for the adults.
9. I will ask my child to treat other participants, coaches, board members, parents and spectators, with respect, regardless of race, sex, creed, or ability.
10. I will refrain from any vulgar, lewd, negative comments, or obscene language or gestures while participating in or watching any league sponsored event, at home or away.
11. I will direct all my comments and criticisms of coaches, parents, participants, officials, board members away from the children participating in the league and other parents, bystanders, etc. and conduct myself in a calm and civilized manner when doing so in any forms of communication (written or verbal) and follow the GYFCA rules in the participant contract pertaining to the issues with GYFCA.
12. I will respect GYFCA rules and regulations and agree to abide by these rules. GYFCA has enacted a zero tolerance policy toward parent behavior. If any rules are broken, the offending parent will be banned from attending any practices, games, or other team functions for the remainder of the season. Violation of this policy will result in the child of the parent immediately being dismissed from the program without a refund for the remainder of the season. Equipment will need to be turned in immediately and in good condition, at which time the equipment deposit will be returned to the parent. All other fees and deposits will not be returned.
13. Video taping or recording of conversations of GYFCA coaches or players is not allowed. Immediate expulsion from the program will occur if you are caught doing this. No refunds will be granted for these violations. On field photographers must have written GYFCA permission to take photos of the coaches and children in the program.

ItheParent/GuardianhavereadtheaboveWaiverofLiability,Policies,LegalProvisionsandCodeof

Conductandfullyunderstandandacceptallterms.

Parent/GuardianSignature Date

Parent/GuardianSignature Date

In order to participate in the program, this form must be signed and dated by both parents. Failure of the parent to read and sign the Parents Code of Conduct will automatically render the parent ineligible to participate in GYFCA activities home or way. In addition, by signing this code of conduct pledge, parents agree to abide by the guidelines set forth above and to conduct themselves in an appropriate manner. GYFCA board members have the sole right to enforce violations.

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Payment Form

(Completed by a GYFCA member)

PaymentPolicy

Fullpaymentisdueatregistration along with your equipment deposit check of 230.00, volunteer deposit check of 100.00, and your fundraising fee check of 100.00. Non-paymentwillresultinaMandatoryDrop.Noequipmentwillbeissuedtoanyparticipantwhohasnotpaid all feesinfullbyJune 8th. A$50returncheckfeewillbeappliedtoallchecksreturnedNSF. All 4checks to be made out to GYFCA.

If you register online, you must still come to an in person registration and pay via a separate check 230.00 for equipment deposit, a check for 100.00 for volunteering deposit, and a 100.00 check for fundraising. You may mail them to GYFCA PO Box 58 Gilberts, IL 60136 in order to be considered fully registered. Until the checks are received and clear, you will not be considered registered. No exceptions.

Subject / Amount / Check # / Cash
Returning Football Player Registration Fee Until March 2nd / 250.00
New Football Players Until March 2nd / 275.00
Football Players After March 2nd / 325.00
Returning Flyweight Football Players (5-6 year olds) Until March 2nd / 200.00
New Flyweight Football Players (5-6 year olds) Until March 2nd / 225.00
All Flyweight Football Players(5-6 year olds) After March 2nd / 250.00
Returning Cheerleaders Registration Fee Until March 2nd / 225.00
New Cheerleaders Until March 2nd / 250.00
All Cheerleaders After March 2nd / 275.00
Board Discount 1 Free Registration
Late Fee ($50 between (6/9/13-8/15/13) / 50.00
Mini-Camp ($20.00): Must register to attend. Shirt Size ______
Misc. Football Equipment (see below)
Fundraising Fee / $100.00
Total Due
Total Paid
Balance Due
Volunteer Fee (refundable) 15 hours are required / $100.00
Equipment Deposit (refundable) / $230.00
Football / Purchased/$
Mouth Piece ($10)
Orange Game Socks ($10)
Orange Practice Jersey ($25)
Chin Strap ($10)
Upgraded Chin Strap ($20)
Upgraded Helmet ($150) One time fee to ensure upgrade each season
Total

Completed By: ______Date: ______

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