Grid Kids Registration FormPlayer Name (required)Date of Birth (required)Grade (required)456Shirt Size (required)YSYMYLYXLASAMALAXLweight(approx) (required)Parent/Guardian (required)Phone (required)Address (required)Player Medical Insurance Company (required)Insurance Policy # (required)Responsible party (required)Emergency Contacts ( please provide 2) (required)Medical Conditions, Health concerns that may affect the players ability to perform resonably assigned tasksunderstand thaI t this is a community youth organization and my childs photo may be published as a participant in the activities he/she has registered forI 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(typed) (required)Date (required)Registration fee $50 plus online processing fee / checks can be made out to ( Irrigon Community Park and Recreation District)For more information contact Wade Aylett @ (541)571-9203There was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.
