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Sign up - Flag Football

You are registering for the following sport and season.  The cost below will be due by the closing registration date.

Please review before continuing your registration.

* Indicates Required Information

Year*
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Season*
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Sport*
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Cost*
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Child Information *
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Often parents take photos during practice or games. These images could be used by PYA in printed publicity material, online publicity (including Facebook and Band), or shared with group members for personal use. *
If there are multiple teams, we can try to keep your child with the indicated friends when possible.
Uniform Size
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Parent or Guardian (1) Information *
Is it OK to text this phone number?
Emergency Contact for Parent or Guardian (1)  *
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Parent or Guardian (2) Information; such as Spouse, Step parent, Grandparent
Is it OK to text this phone number?
Emergency Contact for Parent or Guardian (2) 
Is it OK to text this phone number?
Insurance Information
Informed Consent and Waiver of Liability *

I, the parent or legal guardian, have read and grant permission for my child to participate in the TACKLE FOOTBALL program of Panther Youth Athletics (PYA).  I recognize the fact the TACKLE FOOTBALL is a sport, and that serious injuries can and do occur.  I accept the full responsibility for any injuries that may occur to the player as a result of participating in a PYA program.  I waive any and all liability against PYA, including, but not limited to, PYA, its officers, board of directors, employees, coaches, trainers, and volunteers, and hereby release and discharge the same from any claim, loss, injury, cost, damage, or expense incurred by or on behalf of the player as a result of the player's participation in a PYA program.  I hereby further agree to indemnify and hold harmless all of the above for and from any judgement awarded, attorney's fees, and any other expenses with respect to any claims, loss, or expense which may be sought by or on behalf of the player or player's family or guardian.  I, the undersigned, the parent and/or legal guardian of the player, hereby grant permission for PYA, its officers, employees, coaches, and trainers to authorize medical or dental treatment for the player by any available and qualified physician, dentist, or other trained medical personnel.  In addition, this permission extends to and includes authorization for emergency treatments, procedures, and surgeries for the player.  This permission and authorization includes admission to a hospital facility if the attending physician deems it necessary.  The waiver and release of liability for causes of action arising under or related to the player's participation in the PYA programs continues into perpetuity.

Code of Conduct *

Pather Youth Athletics expects its athletes to conduct themselves with pride, dignity and good character.  As a member of the PYA sports team, I understand that my conduct at practice, games, and road trips represent the organization.  I must maintain proper discipline and not engage in conduct that is negative to PYA or myself.

I also understand that if I violate any of the following rules, I may be subject to disciplinary action as deemed appropriate by PYA administration.  Disciplinary actions may include loss of playing time, immediate suspension for further review of .....

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I have read and understand the rules as described here and am prepared to support my child if / when they face challenges during the season.

Date of Registration *