WHITEHOUSE YOUTH FOOTBALL LEAGUE

Team Member Registration and Parental Consent Form 

 
TEAM MEMBER INFORMATION 
Last Name First Name Middle Initial

Birth Date Grade in Fall Age on September 1 School Attending

(6th graders CAN NOT turn 13 before Dec 1st of current year.)

RETURNING TEAM MEMBER INFORMATION 

Did Team Member play for WYFL last year? __ Yes ___ No if Yes, Number of years Played______ and Jersey
number _____ Please provide four jersey numbers 1. ________ 2. ________ 3. _________ 4. _________

(Please review our FAQ page for how Jersey Numbers are distributed.)

Football __ Flag (5 & 6) ___Freshmen (7 & 8) __Sophomore (9 & 10) __Junior (11 & 12)
Cheerleading __ Flag (5 & 6) ___Freshmen (7 & 8) __Sophomore (9 & 10) __Junior (11 & 12)

PARENT/GUARDIAN MEMBER INFORMATION

Last Name First Name Middle Phone
Initial

Street Address City & State Zip Code

Cell Phone Relation to Team Member: Emergency Contact Name: Emergency Contacts Phone Numbers:

Last Name First Name Middle Initial Phone

Street Address City & State Zip Code

Cell Phone Relation to Team Member: Emergency Contact Name: Emergency Contacts Phone Numbers:

Weight: at Registration (Football Only) Report Card checked if needed:

​Birth Certificate Checked:
TACKLE: $150 FLAG: $75 CHEER: $200 Discounts for families with multiple children -$10 each
Registration Fees Paid & Amount Cash______ Check Number________ Square________
Amount Paid____________ Last Name of Officiant _______________________________

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 WHITEHOUSE YOUTH FOOTBALL LEAGUE

Football and Cheer Waiver and Release of Liability 

I hereby give my permission for to participate in

Whitehouse Youth Football League, Full Contact Tackle Football and Cheerleading Program during the
year this form is signed. ​I further authorize WYFL to provide and/or secure emergency treatment for an
injury or illness of my child, to perform first aid within the limitations of their training, and to take to
and admit, if necessary, my child to a hospital or medical clinic in my absence.

Physician____________________________Phone______________________________

Name of Insurance Carrier if applicable _______________________________________

Pre-Existing Medical Conditions (e.g. allergies or chronic illnesses):

In consideration of the aforementioned youth being allowed to participate in any way in the WYFL
season, together with all related events and activities, the undersigned acknowledges, appreciates, and
agrees as follows:

1. The risk of injury from the activities involved in this program is significant, including the potential for
permanent paralysis and death, and while particular rules, equipment, and personal discipline may
reduce this risk, the risk of serious injury does exist and is known to and acknowledged by me;

2. I understand that my child may be subject to injury from contact with other participants, including
coaches, assistant coaches and officials; falls; the effects of weather; traffic; unforeseen equipment
failure; and, injury resulting from his or her failure to follow instructions concerning appropriate
behavior or playing technique. I understand that the physical activity of participating in this sport may
aggravate pre-existing conditions;

3. I knowingly and freely assume all such risks, both known and unknown, even if arising from the
negligence of the Releases or others, and assume full responsibility for the participation of my child;

4. I certify that my child has no pre-existing medical condition, except as may be specified above, that
would preclude him or her from participating in football, and/or dance and drill and further, I understand
and have been advised that my child should receive a physical examination by a physician or licensed
medical examiner prior to the beginning of participation in this activity;

5. I agree that the Whitehouse Youth Football League may, in its sole discretion, limit participation of
the above-named child due to physical, emotional, or mental disabilities or injury that may be potentially
harmful to him or to other participants;

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 WHITEHOUSE YOUTH FOOTBALL LEAGUE
6. I understand that as a parent or guardian of the aforementioned child I am invited to attend all
practices and games and other activities in which my child participates. I understand and agree that if I
observe any unusual significant hazard during my presence, I will remove my child from participation
and bring such to the attention of the nearest official immediately. I, on behalf of my child, and for
myself, my heirs, assigns, personal representatives, next of kin, hereby release and hold harmless
Whitehouse Youth Football League, its directors, coaches, assistant coaches, officials, and
representatives, other participants, sponsoring agencies and sponsors (“the Releases”), with respect to
any and all injury, disability, death, or loss or damage to person or property, whether arising from the
negligence of the Releases or otherwise. I further understand that the Whitehouse Youth Football
League Board of Directors, officers, coaches, cheer, assistant coaches, and team volunteers are
volunteers and receive no compensation for their efforts;

7. I understand that WYFL carries medical insurance. I understand that this insurance is secondary and
supplementary to any primary medical insurance that I carry and will cover the cost of any uninsured
medical expenses incurred on behalf of my child in excess of a certain deductible as a result of his or her
participation in the football program. I understand it will be necessary for me to first submit any
medical expenses to my own insurance carrier, if applicable, for initial payment prior to making a claim
against the insurance coverage of WYFL. I understand that all claims will be subject to reasonable and
ordinary processing times, and that I will be required to complete claim forms and documentation for
filing such a claim.
8. I understand that the helmet, shoulder pads, and other equipment furnished to my child is the property
of WYFL and hereby agree to return it in the same condition (notwithstanding normal wear and tear) at
the end of the season. If the equipment is not returned I further agree to reimburse Whitehouse Youth
Football League Sports the full replacement cost of damaged or missing equipment.

I affirm that I have read and understand all the foregoing information. I understand that I am giving up
substantial rights by signing this release. I fully, freely and voluntarily consent to waive and release
Whitehouse Youth Football League from liability as specified above and understand this waiver to be a
condition of my child’s participation in the one of Whitehouse Youth Football League season as
required by signature along with date for that season.

***Refunds for football and cheer participants minus $25 fee prior to the last
registration date and must be approved by the President***

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 WHITEHOUSE YOUTH FOOTBALL LEAGUE
CODE OF CONDUCT 
(PLEASE CIRCLE ONE)
Cheer Coach Football Coach Team Mom Official
Volunteer Parent Child
Participants will abide by a Code of Conduct, which includes the following provisions. If any of these rules
are broken, the Officials of Whitehouse Youth Football League shall have the authority to enforce what they
deem necessary. All shall abide by the following:
1 Not to smoke and/or use smokeless tobacco on the practice field around children or inside stadium, I
will never come to practice, game or to volunteer under the influence of alcohol or illegal substances.
2 Not to criticize anyone in front of spectators, but reserve constructive criticism for later, in private or
in the presence of an official and/or coaches and they shall address members if others might benefit.
3 Accept decisions of the game officials and judges on the field and in competitions as being fair and
called to the best ability of said official. I will be knowledgeable in the rules of the game and will
teach these rules to my players, parents, anyone intrigued can look rules up on tri-county website.
4 Not to criticize an opposing team, its players, spirit participants, coaches, or fans by word of mouth or
by gestures. I will be a positive role model for my players and encourage sportsmanship by showing
respect and courtesy and by demonstrating positive support for ALL at every game, practice or other
related events.
5 Strive to make every football and spirit activity serve as a training ground for life, and a basis for good
mental and physical health. Emphasize that good athletes strive to be good students.
6 Together with team officials, be jointly responsible for the conduct and control of team fans and
spectators. Any fan who becomes a nuisance and out of control will be asked to leave.
7 Not use abusive or profane language at any time. I will remember that I am a youth football coach,
and that the game is for the children and not adults.
8 No “pile it on; “mentality. -not to encourage their team to get a commanding lead and raise the score
as high as it can. In these instances, every effort shall be made to let all players play.
9 Not to permit or encourage “sweating down” tactics in order for a player to make the team weight.
10 Not to permit an ineligible player or spirit participant to participate in a game.
11 As a participant of WYFL you’re obligated to volunteer in the concession stand; this affects the whole
league to make everyone happy we love to provide drinks and food. But it cannot be done without
help from everyone.
12 Abstain from the possession and drinking of alcoholic beverages and the possession or use of any
illegal substance on both the game and practice fields.
13 Remove from a game or practice, any participant when even slightly in doubt about his/her health,
whether or not as a result of injury, until competent medical advice is available.
14 Control their fans. Remember, as a team coach, you’re responsible for your team, and fan reaction will
usually be in step with your reaction. Not to deliberately incite unsportsmanlike conduct.
15 No one will be allowed on the stadium field before practice and games, unless they are on the roster,
and/or have an official tri-county lanyard. Parents are not allowed to address the team members
directly at any time, NO EXCEPTIONS.
16 Always leave the field, game or practice, looking better than when you first got there. Keep all trash
picked up.
17 Uphold all rules and regulations of the Whitehouse Youth Football League and Cheer.
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 WHITEHOUSE YOUTH FOOTBALL LEAGUE
PHOTO RELEASE 

I, ___________________________________________( PLEASE PRINT

NAME), hereby grant Whitehouse Youth Football League and Whitehouse
Youth Cheer permission to use team member in a photograph in any and all of
its publications, including but not limited to all of WYFL and WYC’s printed
and digital publications.

I understand and agree that any photograph using my likeness will become
property of WYFL and WYC and will not be returned. I acknowledge that
since my liability form and waiver acknowledge my player participation that
all is voluntary, I will receive no financial compensation.

I hereby irrevocably authorize WYFL and WYC to edit, alter, copy, exhibit,
publish or distribute this photo for purposes of publicizing programs or for
any other related, lawful purpose.

In addition, I waive the right to inspect or approve the finished product,

including written or electronic copy, wherein my likeness appears.

Additionally, I waive any right to royalties or other compensation arising or

related to the use of the photograph(s).

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 WHITEHOUSE YOUTH FOOTBALL LEAGUE

Final Agreement  

I acknowledge that I have carefully read and fully understand the provisions of
these documents. I further acknowledge that I was given the opportunity to consult
with an attorney or any other individual of my choosing before signing this release
and that I have decided to sign this release voluntarily and without coercion or
duress by any person, by signing below, this document represents the final
agreement between parties with respect to the subject matter listed 1-6.

1. Team Member Registration and Parental Consent Release Form

2. Football and Cheer Waiver and Release of Liability
3. Code of Conduct
4. Photo Release
5. Final Agreement

Printed Name_____________________________ Date_________________

​PARENT OR LEGAL GUARDIAN

Signature ________________________________ Dated Initials__________

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