football/cheer clinic registration

FCYL Football/Cheer
Camp & Clinic Registration

This registration is for camp & clinic registration for football and cheer (grades K, 1 & 2 only) for Fall 2024 season.

Registration open through July 8th. Late registrations may not be taken or may be allowed for an increased fee.

NOTE: Registration cannot be completed unless

paid for upon submission ($25 per player).

Please contact the Youth League directly with any questions or concerns.

Player Information

Player First Name

Player Last Name

Birthday

Select the grade for your player for the 2024-2025 school year:

Kindergarten Football Camp

Kindergarten Cheer Camp

Football Clinic (1st/2nd)

Cheer Clinic (1st/2nd)

Select the school your player will attend (2024-2025 school year):

Jackson Elementary

Max Meadows Elementary

Sheffey Elementary

Other

Address

City

State

Zip code

Parent/Guardian Information

First Name (parent/guardian)

Last Name (parent/guardian)

Best Contact Number (cell preferred)

Alternate Contact Number

Does the athlete have any allergies, chronic illness, or medical conditions? Or do you have any requests otherwise? If yes, please describe.

Coaching/Volunteer Interest

I am not interested in volunteering this season.

I am willing to help run the football camp (Kindergarten)

I am willing to help run the cheer camp (Kindergarten)

I am willing to help run the football clinic (1st/2nd)

I am willing to help run the cheer clinic (1st/2nd)

PHOTO AUTHORIZATION: I hereby give my permission for myself/my child to be photographed while participating in Department activities/programs and I give this Department permission to use or distribute such photo and identification. I understand this consent complies with Section 8.01-40 of the Code of Virginia

Yes

ASSUMPTION OF RISK AND AGREEMENT TO PARTICIPATE/CONDUCT POLICY

I, being a participant or parent giving consent, am aware that playing or practicing to play, can be a dangerous activity, involving many RISKS OF INJURY. In consideration for the opportunity to participate, fully recognizing that such an undertaking involves an element of risk, participants and parents assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless, Wythe County, its Parks and Recreation Department, the Parks and Recreation Commission, employees, officers and chaperones, leaders, organizers and sponsors.

The Wythe County Parks and Recreation Department and Parks and Recreation Commission nor any of the said persons shall be held financially responsible for any injury, illness from infectious diseases included but not limited to MRSA, influenza and COVID-19 or death incurred as a direct result of this activity. In the event he or she is unable to communicate from an accident, I hereby give permission that my child may be given emergency treatment by a physician or emergency personnel, to render appropriate medical care, to hospitalize, secure proper treatment, and to order injection, anesthesia or surgery for him or her.

Conduct Policy: Any person or persons showing improper conduct during an activity sponsored by the Wythe County Parks and Recreation Department or Youth Booster Club may be asked to leave the program. Parents will be notified immediately of the circumstances regarding their dismissal. Any person or persons acting in a way that endangers the safety of participants, volunteers, or staff members will be immediately removed from the activity.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. ALSO BY SIGNING, I AM ACKNOWLEDGING THAT THE REQUIRED REGISTRATION FEE ($25) PAID WILL BE NON-REFUNDABLE ONCE OFFICAL PRACTICE/CLINIC DAYS BEGIN. IF THE REGISTERED PLAYER/PARTICIPANT BACKS OUT OF THE SPORT BEFORE THE OFFICIAL SCHEDULED START DATE, HE/SHE WILL RECEIVE A PARTIAL REFUND OF THE SUBMITTED REGISTRATION PAYMENT.

Your Signature

NOTE: Registration cannot be completed unless

paid for upon submission ($25 per player, $30 if late & allowed).

Please contact the Youth League directly with any questions or concerns.

This form no longer accepts submissions.

FCYL Football/Cheer Camp & Clinic Registration

Player Information

Parent/Guardian Information

FCYL Football/Cheer
Camp & Clinic Registration