JAX YOUTH FOOTBALL LEAGUE

REGISTRATION FORM

Participant ____________________ Date of Birth________Address _________________________City ___________   Zip ________Child's Age _____ Phone # _________________ Sex; F M     Grade___________Park name:_______________ School______________________

Agreement, Waiver and Release
In consideration for being permitted by the above district to participate in the JAX YOUTH FOOTBALL LEAGUE, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to be, as a result of participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above person or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in the JAX YOUTH FOOTBALL LEAGUE.

PARENTAL CONSENT: (to be completed and signed by parent/guardian if applicant is under 18 years of age.) I hereby consent that my son/daughter, ___________________________ participate in the JAX YOUTH FOOTBALL LEAGUE, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in the JAX YOUTH FOOTBALL LEAGUE. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any injury or property damage that said minor may sustain while participating in the JAX YOUTH FOOTBALL LEAGUE.

I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE JAX YOUTH FOOTBALL LEAGUE AND I SIGN IT OF MY FREE WILL.

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Signature of Parent/GuardianName                                                                 (Printed)                              Date