Você está na página 1de 3

2013 Lawrenceville Jr.

Pro Application/Authorization Team: _____ 3rd/4th _____ 5th/6th ______ 7th/8th

*Grade at the start of the 2013-2014 school year

Players Name ______________________________________________ Address ___________________________________________________ Phone: ________________ School ____________________________ Wt ________

Grade _____ DOB ____/____/_____ Ht _________

Emergency Contact ______________________ Number ____________ Family Physician _________________________ Player Insurance Co. ______________________ Policy Number ____________ Participation in Lawrenceville Jr. Pro Football requires strenuous physical activity and contact. Does your child have any medical condition that limits his/her ability to participate in this activity? _____ yes _______ no if yes, please explain __________________ Does your child have any medical condition that medical personnel should be aware of? _____ yes ______no if yes, please explain _______________________________ List of medications player is currently taking (if any) __________________________
I understand that participation in football may result in serious injury and that protective equipment does not prevent all injuries to players. I do hereby waive, release, absolve, indemnify, and agree to hold harmless the Lawrenceville Jr. Pro football coaches, organizers, and sponsors for any claim arising out of any injury to my child whether the result of negligence or any other cause, except to the extent and the amount covered by accident or liability insurance. The undersigned authorizes the coaches of Lawrenceville Jr. Pro Football, in my/our absence, to consent to such emergency medical care for the above named player as they shall be advised by any physician is necessary by any medical emergency which arises by reason of injury or otherwise participation in Lawrenceville Jr. Pro football activities. I also agree to return, upon request, the uniform/ equipment issued to my child.

__________________________________________ Signature of Parent or Legal Guardian

_________________________ Date

2013 Lawrenceville Jr. Pro Football Sign-ups

Fees: $30 for one player, $25 (each) for two or more players - must complete separate application for each player. Schedules: Available at a later date Equipment: Distribution dates will be announced. Watch for information in the Daily Record or listen to WAKO Radio on 103.1 FM

There are many activities in which Lawrenceville Jr. Pro Football could put your time and talents to good use. For example: concessions, ticket sales, clean up and chain gang. Are you interested in helping our younger players? Yes, please call me _______________________________________________ Phone numbers __________________________________________________ concession ________ tickets _________ chains ________ clean up _________

Fees Paid $__________ Check_______ Cash _______ Please mail to 1903 16th St Lawrenceville, IL or drop by Lawrenceville High School office

Lawrenceville Jr. Pro Uniform Information Player Name_________________________ ___________________ Phone #

Grade at the start of the 2013-2014 school yr. _________________ Parent/Guardian Name_________________________________ Player Number 1st choice__________________ 2nd choice _________________ Size YM_______ YL _______ AS _____ AM _______ AL ______ AXL ______ AXXL _______ other _________ You get to keep your jersey at the end of the season.