Participant's Name *

First Name

Last Name

Phone

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Family/Emergency Information

Father's Name

First Name

Last Name

Phone

(###)

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Family/Emergency Information

Mother's Name

First Name

Last Name

Phone

(###)

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T-Shirt Size For Player

Youth - XXL

Youth - XL

Youth - L

Youth - M

Youth - S

Adult - XXL

Adult - XL

Adult - L

Adult - M

Adult - S

If under the age of 18, Parent or Guardian's Name

First Name

Last Name

ALLEMAN JR. PIONEER PARTICIPATION - INFORMED CONSENT *

As I enroll my child for participation, from observing and/or playing football I am aware of and acknowledge that injuries can happen. I also accept the risk of injuries that are a possibility to participants. I acknowledge the following regarding the philosophy and teaching of Alleman Jr. Pioneer Football program and its coaches. As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor (“participant”). I am aware that participating in sports will involve travel to practices and games. I acknowledge and accept the risks involved with my child’s travel. I further understand that participation in sports presents to my child the risk of harm, including, but not limited to, serious personal injury or death. Any questions I have concerning my child’s participation have been answered. LIABILITY WAIVER: In consideration of my child being allowed to participate in the sport(s) indicated above, I hereby RELEASE AND AGREE TO INDEMNIFY AND HOLD HARMLESS the Catholic Diocese of Peoria, the parish, the school, coaches, chaperones, volunteers or representatives associated with the event, and their employees and agents, from any and all liability for injuries, damages, medical expenses, or any other loss to my child or family or me (including attorneys’ fees) arising from or related to my child’s participation. Also, I give my consent and approval for my child’s name and picture to be printed in any sports program, publication, or video. As a parent/guardian, I further acknowledge that I am a role model. I will remember that school athletics is an extension of the classroom, offering important learning experiences for the students. Therefore, I will show respect for all players, coaches, spectators, and officials. I will only participate in cheers that support, encourage, and uplift the teams involved. I understand the spirit of fair play and good sportsmanship expected by a Catholic school. I accept the responsibility that comes with being a parent/guardian of a student-athlete. The coach will discuss team rules with the players and the consequences for inappropriate behavior on and off the field. As parent and child, we will assume responsibility for the proper maintenance and functioning of the equipment they will wear for practices and the game. I also recognize that if during practice my child feels uncertain, uncomfortable, or in any pain they will be instructed by coach and parent alike to immediately bring this to the attention of a coach on site. In addition, if in the event my child is removed under suspicion of concussion, I understand that he cannot return to practices or games until cleared by a doctor.

First Name

Last Name