Player Registration Digital Forms

Southwest Kansas Youth

8-Man Football League

Ellinwood Junior Eagles Football Club

IF YOU ARE GOING TO BE IN THE 3rd, 4th, 5th, or 6th GRADE THIS COMING SCHOOL YEAR, AND WOULD LIKE TO

PLAY TACKLE FOOTBALL -- READ ON!!

Teams are broken into 3rd/4th Grade and 5th/6th Grade.

The season consists of six regular season games, with the top teams playing in a Championship Tournament with date, location and time TBD.

REGISTRATION INFORMATION: The Official Registration/Medical Liability Release Form must be completed and returned to your Ellinwood Junior Eagles Football Club coordinators.

The Official Registration/Medical Liability Form must be kept in a book and be carried by the Head Coach of each team to practices and games.

Physicals and copies of birth certificates must be turned in prior to the first practice in August. No player may practice prior to returning this form or participate without a current athletic physical.

Practice and game dates will be posted to the Ellinwood JR. Eagles Facebook page. Games will begin in September for all grade levels. No player may check out equipment unless he or she has paid the dues and submitted the Official Registration and Medical Liability Release Form.

If you have questions regarding the Ellinwood Junior Eagles Football Club, please email ellinwoodjreagles@gmail.com or call

Justin Joiner at (620) 791-7032.

Medical Liability and Participation Liability Release

I, the undersigned, herein certify that I am the parent or legal guardian of the above-named participant, a player in the Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club and I am fully aware and understand that football is a contact/collision sport. As a result of this awareness and understanding; I acknowledge that serious injury is a possibility of participation in the Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club. I further acknowledge that officials of the Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club have made me aware of potential serious injury. With full knowledge of the risk, I herein request that my son, daughter or charge be permitted to play. Now, therefore, I (we) do hereby waive, release, absolve, indemnify and agree to hold harmless the Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club, its organizers, supervisors, participants, and facilities for any claim arising out of an injury to the player. As a parent or legal guardian of the above-named participant, a player in the Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club, I hereby grant permission to the adult manager, coach, league representative and/or business manager of the team to obtain medical care from any licensed physician, hospital, or medical clinic for the player named herein at such times as either parent or legal guardian cannot be contacted in person or by telephone. This authorization shall include all Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club activities, including the period required to travel to and from those activities; and I (we) do hereby waive, release, absolve, indemnify and agree to hold harmless the Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club, its organizers, supervisors, participants, and persons transporting the player to and from those activities, for any claim arising out of an injury to or treatment of the player.

Parent 1 (First & Last Name)

Address

Phone

Parent 2 (First & Last Name)

Address

Phone

Player Name (First & Last)

Player Birthday

Month

Day

Year

Player Grade

Sports Physical

You may scan a copy of your players sports physical or turn in a physical copy.

Concussion Info. Release

You may scan a copy of your players concussion information form or turn in a physical copy.

Player Registration Fee

Per Player$125

Registration Paid by Check/Cash$0

Need to speak with someone about delayed payment or scholarship.$0

If you need assistance or would like a scholarship for the registration fee, please let us know. The Ellinwood Jr Eagles wants every child wanting to learn and grow through footbal to have the opportunity to play.

Donation

$10

$20

$30

There is a blank field for a custom donation amount. We appreciate any donation amount to help keep equipment updated and our kids safe.

If you have any questions or would like one of the coaches or leaders reach out to you, please let us know. One of our leaders or coaches will reach out to provide answers.

Health Insurance Information (Insurance Company and Policy/Certificate #)

Please list any known allergies or mark NKA (none):

Please list any medications your player currently takes or any special medical conditions:

Parent Signature

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By signing, you are agreeing to have your child play for the Ellinwood Junior Eagles tackle football club, acknowledging release of medical liability and release of participation liability.

Ellinwood Junior Eagles

PLAYER PHOTO RELEASE

Ellinwood Junior Eagles shares information about our youth tackle football program on social media platforms and on our website. Photos of our players may appear on social media and/or our website. Check out our social media pages and website for examples.

By signing below, you are giving permission to use photos of your child for club promotion purposes, inclusion in the annual team photo, and participation in our annual player spotlights.

Player Name (First and Last):

Use of my child's photo on social media:

Yes

Note that if you do not wish to have your child pictured on social media, they will not be apart of the team photo.

Use of my child's photo on website:

Yes

Signature

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Ellinwood Junior Eagles

RELEASE AND WAIVER OF LIABILITY

This Release is by the party signing below (herein referred to as “Releasor”), and is given to Southwest Kansas Youth 8-Man Football League, Ellinwood Junior Eagles Football Club, Heads Up Football, LLC, USA Football, Inc., and each of their respective subsidiaries, affiliates, divisions, owners, officers, agents, board members, employees, consultants, grantors, sponsors, agents, legal representatives, administrators, assigns, heirs, executors, those for whom each is acting and those acting with any of their authority and permission (collectively as “Releasees”).

RELEASE OF ALL CLAIMS. Releasor, being of lawful age (or, in the case of a minor, through his/her parent or guardian), in consideration of being permitted to participate in the football and cheer program, including football games, practices, workouts, camps and clinics, jamborees, scrimmages, and post-season competitions (collectively and individually, the “Season”), hereby releases and discharges Releasees from all present and future liabilities, debts, obligations, costs, expenses, damages, losses, charges, judgments, executions, liens, claims, demands, actions or causes of action of whatever nature or description, in equity or at law, whether caused in whole or in part by the Releasees or any other person or thing during the Season while Releasor is present, which the Releasor or his/her child or ward (each a “child”), family, estate, heirs, representatives, executors, administrators, successors or assigns (collectively, "Related Parties") may have, whether known or unknown, suspected, asserted or not asserted, arising out of participation by the Releasor or his/her child in the Season, and agrees that Releasees are not responsible for any of the foregoing arising out of the Season, even if caused by their ordinary negligence. The Releasor understands, acknowledges and accepts that this Release and Waiver is intended to be binding on the Releasor and anyone related to Releasor.

Release of All Claims - Initial to Acknowledge

RISKS ACCEPTED; MEDICAL TREATMENT. The Releasor further understands, acknowledges and accepts that participation in the Season involves certain inherent risks, including, but not limited to, property damage, economic loss and serious bodily injury (including death), and agrees that the Releasor or his/her child is voluntarily participating in the Season with full knowledge of the risks involved and accepts all risks of participation. The Releasor declares that the Releasor or his/her participating child is physically fit and has the requisite skill level to participate in the Season. The Releasor authorizes Southwest Kansas Youth 8-Man Football League and Ellinwood Junior Eagles Football Club to provide medical treatment to the Releasor or his/her child, at the Releasor's cost, should the need arise. The Releasor understands, acknowledges and accepts that he or she must provide his/her own medical insurance for the participant.

Risks Accepted; Medical Treatment - Initial to Acknowledge

GRANT OF PUBLICITY RIGHTS. The Releasor further grants the Releasees the right, but does not otherwise impose the obligation, to photograph, videotape and/or otherwise use the Releasor and/or his or her participating child’s name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising and promotional materials, free of charge without reservation or limitation.

The Releasor understands, acknowledges and accepts that this Release and Waiver of Liability is intended to be as broad and inclusive as permitted by the laws of the state(s) in which the Season is taking place and agrees that if any portion of this Release and Waiver is invalid, the remainder will continue in full legal force and effect.

Grant of Publicity Rights - Initial to Acknowledge

League Name:

Southwest Kansas Youth 8-Man Football League

Club Name:

Ellinwood Junior Eagles Football Club

Parent Full Name:

Parent Phone:

Parent Address (City, State, Zip):

Player Full Name:

Player Age:

Player Grade:

Signature

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