Grid Kid Football Registration

Player Name (required)

Date of Birth (required)

Grade (required)

Gaurdian Name (required)

Relationship to player (required)

Address (required)

Phone number (required)

Insurance Company and Policy # (required)

Responsible Party (required)

Emergency contacts ( Please provide 2 ) (required)

Medical Conditions (required)

I understand that this is a community youth organization and my childs photo may be published as a participant in the activities he/she has registered for (required)

I understand that I, the parent/guardian, am responsible for all injury costs that may occur to my child. I hereby agree to assume all risks of personal injury that may arise from participating on the football team, understanding that this sport does involve the potential for injury and waive and release Irrigon Junior Senior High School, AC Houghton Elementary, Irrigon Elementary, Irrigon Grid Kids, City of Irrigon, Irrigon Community Park & Recreation Dist. and staff from liability from any injury or illness that may be sustained during this football season

Parent/ Guardian Signature (required)

Date (required)

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