FOOTBALL REGISTRATION FORM

2017 KNOX COUNTY JUNIOR FOOTBALL

REGISTRATION, EMERGENCY INFORMATION & CONSENT FORM
**(ONE FORM FILLED OUT FOR EACH ATHLETE) **
REGISTRATION COST IS:
- $75.00 FOR THE FIRST CHILD AND,
- $65.00 FOR EACH ADDITIONAL CHILD.
*Registration cost is due when application is turned in.*

Athletes Name ______________________________________DOB______________________

Athletes School and Grade____________________________ AGE as of 08/01/2017_________
Physical Address__________________________________________________________ ______
Home Phone___________________________________________________________________
Fathers Name_________________________________________________________________
Physical Address_______________________________________________________________
Employer & Address____________________________________________________________
Home Phone_________________ Work Phone_______________ Cell Phone_______________
MothersName_________________________________________________________________
Physical Address_______________________________________________________________
Employer & Address____________________________________________________________
Home Phone__________________ Work Phone________________ Cell Phone_____________
Family Medical Insurance
Carrier______________________________________ Group ___________________________
Policy Number____________________________ Group Number_________________________
ID Number_________________________________
Participant Physician Name_______________________________________________________
Address______________________________________________________________________
Phone Number_______________________ Emergency Contact Number___________________
Allergies (list): _________________________________________________________________

Serious Medical Conditions_________________________________________________

I /We hereby grant consent to any and all health care providers designated by the Knox County Junior Football &
Cheerleader Program to provide my child ___________________________ any and all necessary medical care
(Printed name)
as a result of any and all injury / illness.

This consent includes first aid and transportation to / from health care providers and/or facilities.

_____________________________________________ ____________________
Signature of Parent / Guardian Date

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FOOTBALL REGISTRATION FORM
2017 KNOX COUNTY JUNIOR FOOTBALL
PARENT / GUARDIAN AGREEMENT
**(ONE FORM FILLED OUT FOR EACH ATHLETE) **

I, ___________________________________________ (print name), certify that I am a legal parent/guardian of,

_______________________________________ (print player name), who will be a participant of the (circle one)

5-6 7-8 9-10 11-12

team in the Knox County Junior Football & Cheerleading Program.

I do hereby agree that I have read, understand, and agree to abide by the information and rules contained in the accompanying
information packet, as well as any other program and team rules that I may be advised of in the future.

I have read, understand, and agree to all terms and conditions of the accompanying Registration Form, Media / Internet Photo Release
Form, the Emergency Information and Consent Form, and the Parent Volunteer Form.

I agree to provide the Knox County Junior Football & Cheerleading program with all necessary information that they may need or
deem necessary concerning my participating child, and
I further agree to fully and completely fill out and turn in all forms required by the Knox County Junior Football & Cheerleading
Program prior to my child participating.

I agree that any devices or medicines required by my child are to be administered by the parent / guardian only. I agree to make the
coach for the team aware of any health problem and am responsible for providing all necessary administration of medications and
devices. I further agree that it has been strongly recommended to me that my child have physical examination performed by a medical
professional before participating.

I agree to pay in full, all necessary program costs and fees prior to my child participating.

I understand that by registering the above named child in the Knox County Junior Football& Cheerleading League I assume complete
risk of any health related issues. I further understand that equipment will be issued to the child at no additional cost. I am responsible
for its return in satisfactory condition and clean. I agree to return it on or before the stated turn in date. If I fail to return all of the
equipment in satisfactory condition and clean, I agree to pay all costs incurred for the collection of the equipment including, but not
limited to, attorneys fees, court costs, replacement costs, repair costs, and cleaning costs.
Current cost is $220.00 per league owned uniform (helmet, pads, pants, practice jersey)

Parent/guardian printed name ___________________________________________

Parent/guardian signature _________________________________Date__________

** PLEASE CIRCLE ONE OF THE FOLLOWING **

NEW PLAYER RETURNING PLAYER FROM 2015

** PLEASE CHOOSE ONE OF THE FOLLOWING FOR RETURNING PLAYERS ONLY **

_____ My child WILL use their game jersey from last season
_____ My child WILL NEED a new jersey for this season
** RETURNING PLAYERS NEEDING NEW JERSEY AND NEW PLAYERS **

** PRINT CHILDS NAME ONLY IF YOUR CHILD WILL BE GETTING A NEW GAME JERSEY **
** New players MUST fill in this section **

_____________________________________________________________________________________________________________________
**PRINT YOUR CHILDS NAME AS YOU WANT IT TO APPEAR ON THE BACK OF GAME JERSEY. **
LAST NAME OR FIRST INITIAL AND LAST NAME ARE NORMAL

NUMBERS ON GAME JERSEYS WILL BE DETERMINED AND ARRANGED BY EACH CHILDS COACH.
INDIVIDUAL NUMBER REQUESTS ADDED TO THIS FORM OR REQUESTED AT THIS TIME WILL NOT BE HONORED.
Please turn in applications to Sonnys Sporting Goods or Hinkle Insurance.