2023 Edgefield County Youth Football League Football Registration Form "*" indicates required fields 1Players Information2Parental Information3Pay & Submit Players InformationPlayer's Name:* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Player's Birth Date:* MM slash DD slash YYYY Age as of September 1, 2023:*Team Played for last Season:* Jersey Size:*Youth SmallYouth MediumYouth LargeYouth Extra LargeAdult SmallAdult MediumAdult LargeAdult Extra Large Parental InformationFather's Name: First Last PhoneMother's Name First Last PhonePrimary Contact for practice and games:* Would you the Parent be willing to Volunteer with the League: Head Coach Assistant Coach Concession Duty PARENTAL AUTHORIZATION: I, parent or guardian of the named candidate above for a position in above mentioned baseball program, hereby gives approval to his/her participation in any and all league activities during the current season. I assume all risks and hazards incidental to such participation including transportation to and from the activities; and do hereby waive, release, absolve, indemnify and agree to hold harmless the parent or local league organization, the organizers, sponsors, supervisors, participants and persons transporting the player to and from activities, for any claim arising out of an injury to the player, except to the extent and in the amount covered by accident and/or liability insurance held by the local league. I also grant permission to managing personnel or other league representatives to authorize and obtain medical care from any licensed physician, hospital or medical clinic should the player become ill or injured while participating in league activities away from home, or at other times when neither parent, nor guardian is available to grant authorization for emergency treatment. I agree to return upon request the uniform and other equipment issued to the player in as good a condition as when received, except for normal wear and tear. I will furnish a certified birth certificate of the above named candidate upon request by league officials.* I agree.After registration you may MAIL your check to: Edgefield County Recreation Department 206 Penn St., Suite 6 Edgefield, SC 29824. Make checks payable to Edgefield County Recreation Department. Registration fee is $50.00* I UNDERSTANDSignature:* First Last By signing your name electronically on this Registration Form, you are agreeing that your electronic signature is the legal equivalent of your manual signature on this Form. Youth FootballCredit Card*Card Details Cardholder Name
