MONONA GROVE EAGLES YOUTH FOOTBALL
7^th and 8^th Grade
Registration Form Fall 2010

Student Information:

Last Name_______________________________ First Name_______________________________  

Grade-Fall 2010__________ School Attending __________________________Weight_________Date of Birth___/___/___ 

I/We the parents of the above named candidate for a position on a MGYF Monona Grove Eagles Youth Football team hereby give my/our approval to their participation in any and all Alliance League activities during the current season. I/We recognize that participation in football may result in serious injury and/or death. 

I/We do hereby waive, release, absolve, indemnify, and agree to hold harmless the Monona Grove Youth Football League, Monona Grove School District, City of Monona, the organizer, sponsors, supervisors, participants and persons transporting my/our child to or from activities, for any claim arising out of an injury to my/our child, except to the extent and in the amount covered by accident or liability insurance. 

The Player whose name appears on the registration form shall not have lost any unreasonable amount of body weight (unreasonable is considered 3-5 lbs. dependent upon the Player’s health/weight condition prior to any weight loss) in order to officially register in a lower weight classification than his normal and healthiest body weight. 

I/We agree to return upon request the uniform and other equipment issued to my/our child in as good a condition as when received except for normal wear and tear. I/We will be subjected to a $300 equipment fee for failure to return all equipment as required.

Student's Name_______________________________________________________

 PHONE__________________________________MOBILE PHONE_______________________________

ADDRESS___________________________________________________________________________________________

Father's Name (Print)__________________________________________  Mother's Name (Print)_________________________________________

Father’s Signature ______________________________  Date __________Mother’s Signature _____________________________Date  _________
Important: BOTH PARENTS or Guardian(s) MUST SIGN

WHO TO CONTACT IN CASE OF AN EMERGENCY:

NAME______________________________________PHONE_____________________MOBILE PHONE_________________________

HOSPITAL__________________________________________________ PHONE_______________________________

PHYSICIAN_________________________________________________ PHONE___________________________________

NAME OF INSURANCE COMPANY ______________________________________________________________________

Medical restrictions (i.e. needs inhaler) please explain:______________________________________________________

Send completed registration form with check in the amount of $90 no later than June 12^th 2010 payable to:Monona Grove Eagles Youth Football,  PO BOX 21 Cottage Grove, WI 53527.  Practice begins Tuesday August 10th, 2010.
                                                                                            DO NOT WRITE BELOW THIS LINE

                                                                                                                          Director’s Signature  ____________________________________________


Official Weight     ________________             Date  ____________               Coach’s Signature   _____________________________________________
(Director Only)