| CENTER JR. COUGARS |
| Football or Cheer ___Jr. Pee Wee 6 to 8 ___Pee Wee 9 & 10 ___Jr. Midget 11 & 12 ___Midget 13 & 14 (please check one) |
| FOOTBALL & CHEER 2008 Registration Form |
Participant's Name__________________________ School_________________ Returning? Y N
Home Address_________________________________City__________________ Zip _______
Birth Date_______________ Age On August 1st_________ Grade In School Next Year______
Father's/Guardian's Name_____________________________ email ______________________
Hm Phone________________ Wk Phone_________________ Cell Phone __________________
Mother's/Guardian's Name_____________________________ email ______________________
Hm Phone________________ Wk Phone_________________ Cell Phone __________________
Emergency Contact_______________________________________ Phone # _______________
Health Insurance Company _______________________________ Policy # _________________
Physician Name ______________________________________ Phone # __________________
Allergies to Medications or Bee Stings_______________________________________________
Have you ever had any serious illness, surgery, or injury? If yes, please describe and give dates.
_____________________________________________________________________________
List medications routinely taken_____________________________________________________
Home Address_________________________________City__________________ Zip _______
Birth Date_______________ Age On August 1st_________ Grade In School Next Year______
Father's/Guardian's Name_____________________________ email ______________________
Hm Phone________________ Wk Phone_________________ Cell Phone __________________
Mother's/Guardian's Name_____________________________ email ______________________
Hm Phone________________ Wk Phone_________________ Cell Phone __________________
Emergency Contact_______________________________________ Phone # _______________
Health Insurance Company _______________________________ Policy # _________________
Physician Name ______________________________________ Phone # __________________
Allergies to Medications or Bee Stings_______________________________________________
Have you ever had any serious illness, surgery, or injury? If yes, please describe and give dates.
_____________________________________________________________________________
List medications routinely taken_____________________________________________________
I understand that there are risks of physical injury associated with, arising out of and inherent to the activity of football/cheerleading. In
recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all rights and/or causes of action of any kind, including
any and all claims of negligence arising as a result of such activity from which liability could accrue to Center/Antelope Jr. Cougars, its
officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities (hereinafter collectively referred to
as "CAJC").
I hereby agree to release CAJC and hold CAJC harmless of all liability, and hereby acknowledge that I knowingly and voluntarily
assume full responsibility for all risks of physical injury arising out of active participation in football/cheerleading on behalf of the
participant.
I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I
have signed this document voluntarily and of my own free will in exchange for the privilege of participation.
If I am a minor, my parent and/or guardian has signed this document releasing CAJC from any and all such liability described above
and has acknowledged that I am knowingly and voluntarily assuming all risks of injury inherent to this activity.
The above named student has my permission to participate in all CAJC events. I warrant the above information is complete and
correct. I hereby authorize the event directors or their agent to act on my behalf to provide emergency medical treatments. I further
release CAJC of all liabilities associated with my child attending any CAJC events. I also give CAJC permission to use photos &/or
video of my child in or on any form of advertisement.
I understand that ANY FEES PAID are non-refundable and does not guarantee my child a position on any Center/Antelope Jr. Cougar
Cheer Squad or Football Team. All equipment remains the property of CAJC. I understand that by signing this form I assume
responsibility for replacement cost in the event of failure to return equipment. I understand that try-outs will be held for both
Cheerleading and Football and my son/daughter's participation is subject to those try-outs. I also understand that previous
participation in the CAJC program does not guarantee my child a position with the association in the current calendar year.
I am aware that it is mandatory for my child to participate in fundraising throughout the 2008 season.
________________________________________________________ __________________________
Parent/Guardian Signature Date
recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all rights and/or causes of action of any kind, including
any and all claims of negligence arising as a result of such activity from which liability could accrue to Center/Antelope Jr. Cougars, its
officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities (hereinafter collectively referred to
as "CAJC").
I hereby agree to release CAJC and hold CAJC harmless of all liability, and hereby acknowledge that I knowingly and voluntarily
assume full responsibility for all risks of physical injury arising out of active participation in football/cheerleading on behalf of the
participant.
I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I
have signed this document voluntarily and of my own free will in exchange for the privilege of participation.
If I am a minor, my parent and/or guardian has signed this document releasing CAJC from any and all such liability described above
and has acknowledged that I am knowingly and voluntarily assuming all risks of injury inherent to this activity.
The above named student has my permission to participate in all CAJC events. I warrant the above information is complete and
correct. I hereby authorize the event directors or their agent to act on my behalf to provide emergency medical treatments. I further
release CAJC of all liabilities associated with my child attending any CAJC events. I also give CAJC permission to use photos &/or
video of my child in or on any form of advertisement.
I understand that ANY FEES PAID are non-refundable and does not guarantee my child a position on any Center/Antelope Jr. Cougar
Cheer Squad or Football Team. All equipment remains the property of CAJC. I understand that by signing this form I assume
responsibility for replacement cost in the event of failure to return equipment. I understand that try-outs will be held for both
Cheerleading and Football and my son/daughter's participation is subject to those try-outs. I also understand that previous
participation in the CAJC program does not guarantee my child a position with the association in the current calendar year.
I am aware that it is mandatory for my child to participate in fundraising throughout the 2008 season.
________________________________________________________ __________________________
Parent/Guardian Signature Date
For Official Use Only
amt__________type_________name___________________________initials_________
amt__________type_________name___________________________initials_________
| 2008 REGISTRATION FORM *Football Program Cost: $225 non-refundable deposit due at registration of $50, balance due by August 1, 2008 *Cheer Program Cost: $300 non-refundable deposit due at registration of $100, balance due by uniform fitting in June (date to be announced) All parents/guardians are required to work 10 hours per child in the league. There is a refundable $100 deposit for equipment & parent participation hours due at registration. This deposit will be refunded upon completion of your 10 hours. All participants must have a physical exam completed AFTER April 1, 2008 and BEFORE July 31, 2008 New players and cheerleaders MUST provide an original birth certificate AT THE TIME OF REGISTRATION. Returning players and cheerleaders do not need birth certificates. **REGISTRATIONS WILL BE HELD AT MOUNTAIN MIKE'S PIZZA** (4207 Elverta Road in the Winco shopping center) FOR DATES AND TIMES CHECK OUR WEBSITE AT www.antelopejrcougars.com MAIL COMPLETED REGISTRATIONS TO: CENTER/ANTELOPE JR. COUGARS PMB# 188 4117 Elverta Road, Suite 102 Antelope, CA 95843 Regular season practices begin in August. Games are played on Saturdays, September-November. Practices and home games will be held at Center High School. ***If registering your child please sign here stating that you received both pages of the registration form____________________________________________________ **CAJC HOTLINE: (916) 491-1773 |
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