TeamPages: Putnam Valley Football Club - PUTNAM VALLEY FOOTBALL CLUB REGISTRATION - FALL 2023

PUTNAM VALLEY FOOTBALL CLUB REGISTRATION - FALL 2023

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Pricing Details

$ 0.00 Total:

PUTNAM VALLEY FOOTBALL CLUB REGISTRATION - FALL 2023

* Please be sure to fill out all sections of this form and read and sign off on the Registration Policy Statement, Informed Consent and Photo Release statements. Registration is not final until fully completed, signed forms are submitted *

PLAYER’S NAME:

Name:

PLAYER’S GRADE:

PLAYER’S DATE OF BIRTH:

PLAYER’S GENDER:

MaleFemale

PLAYER’S WEIGHT:

PARENT / GUARDIAN NAME:

Name:

PARENT / GUARDIAN ADDRESS:

Street Address:
City: State/Province: Country: Zip/Postal Code:

PARENT / GUARDIAN HOME PHONE NUMBER:

PARENT / GUARDIAN CELL PHONE NUMBER:

PARENT / GUARDIAN EMAIL ADDRESS:

FAMILY PHYSICIAN NAME:

Name:

FAMILY PHYSICIAN PHONE NUMBER:

DOES YOUR CHILD HAVE ANY MEDICAL CONDITIONS OR KNOWN ALLERGIES? (Medical, Food or Other)? If so, please check the appropriate box below and provide an explanatin in the “Additional Information” section.

Medical ConditionAllergies

Additional Information

ADDITIONAL CONTACT – OTHER PERSON TO CONTACT IN CASE OF EMERGENCY:

Name:

Relationship to Player

ADDITIONAL CONTACT HOME PHONE NUMBER:

ADDITIONAL CONTACT CELL PHONE NUMBER:

Volunteering

Please indicate your interest in which volunteer activities you would like to participate in. Please also complete the Volunteering Form to provide details.

I CAN HELP WITH:

FundraisingConcession standEquipment / UniformOther

IF OTHER, PLEASE PROVIDE DETAILS:

REGISTRATION AND POLICIES STATEMENT

I assume all risk of personal injury involving this program. Acting on the behalf of my child, I do here by release the Putnam Valley Football Club, Putnam Valley Parks and recreation Dept., Putnam Valley Central School Distract, their staff, instructors, coaches and volunteers of liabilities including’s claims and suits of law or equity, for any injuries which results directly or indirectly by reason of participation in this football program, I am aware that the Putnam Valley Football Club does not provide any accident insurance.

INFORMED CONSENT STATEMENT

I hereby give permission for the child listed above to participate in the 2023 Putnam Valley Football Club season and my child is in good health, and does not have any health related restraints that would not allow him/her to participate in such physical activity. It is my understanding that my child will comply with the policies of the Putnam Valley Football Club and the coaches / instructors. My child and I are aware that participating in the Putnam Valley Football Club is a potentially hazardous activity. We assume all risk associated with participation in sports or activity. I acknowledge that even with the best coaching, supervision, and observance of rules. Injuries are still possibility. I also understand that I have to either pick my child up or arrange to have transportation for my child at the beginning and end of each practice, game or activity.

Further, I authorize the coach / instructors to provide emergency treatment of any injury or illness my child may experience if qualified personnel consider treatment necessary and perform the treatment. This authorization is granted only if I cannot be reached and a reasonable effort has been made to do so.

PHOTO RELEASE STATEMENT

I Hereby grant permission for Video recordings and digital photographs to be taken of my child as part of his or her participation in the Putnam Valley Football Club. I Understand that the recordings and images will be collected for the use in our Year end Program and team video for our club.

I authorize Putnam Valley Football Club to use my child’s images on its websites and or in printed promotional materials without further consideration and I knowledge Putnam Valley Football Club right to treat the media (such as cropping) at its discretion.

I also acknowledge that Putnam Valley Football Club may choose my child’s image at this time, but may do so at a later date.

I understand my child’s image is posted on the Putnam Valley Football Club website the image can be downloaded by a third party. I agree that I will not hold Putnam Valley Football Club responsible for any harm that may arise from such unauthorized reproduction.

By checking this box, and adding my electronic signature below, I confirm that I have read and also understand the Registration and Policies statement, the Informed Consent Statement and the Photo Release Statement.

ELECTRONICALLY SIGNED BY (Name of Parent/Guardian completing this form):

DATE SUBMITTED:

or cancel

Putnam Valley Football Club

PUTNAM VALLEY FOOTBALL CLUB REGISTRATION - FALL 2023

Pricing Details

$ 0.00 Total:

PUTNAM VALLEY FOOTBALL CLUB REGISTRATION - FALL 2023

Volunteering

REGISTRATION AND POLICIES STATEMENT

INFORMED CONSENT STATEMENT

PHOTO RELEASE STATEMENT

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