GRANTS RECREATION

 T.D.Y.F.L (Ty Detmer Youth Football League Registration)

 PLEASE FILL OUT BOTH PAGES

This fee covers cost of insurance and equipment. The insurance is a supplemental insurance policy only, with a $250.00 deductible, equipment includes: Jersey, pants & helmet which all must receive a uniform.  Your child will not be allowed to practice until physical has been taken.

 PLAYERS NAME: _______________________________________________________________________

Birth Certificate Required (Please mail a copy of your child's Birth Certificate with form and payment)

DATE OF BIRTH: ________________________________

 Age as of September 1^{st 2007}:_________  Grade as of September 1^{st 2007}:________

 PHONE NUMBER: ( Home) ___________ (Work) ____________(Cell)_____________

 ADDRESS: _______________________________________________________________________

                                                                        City                 State                Zip

 DID YOUR CHILD PLAY LAST YEAR? Yes__________ No__________

 IF SO WHAT TEAM? _____________________________________________________

 Are there any physical problems that the Grants Recreation Department and the coach should know about:            Yes__________ No___________?

 I hereby certify that the above named child is physically able to play football and has no impairments.  I hereby agree to indemnify and hold harmless the Grants Youth Football League and the City of Grants Parks, Recreation Department, its Directors, Officers, Coaches, Sponsors, Staff and any affiliates from and against all liability because of any bodily injury, personal injury or property damage which may occur or result from the participation of the above named child in any and all activities of the G.Y.F.L.  (Including practices).

 I agree to return at the end of the season the uniform and other equipment issued to my child in as good as condition as when received except for normal wear and tear and to reimburse the league for the shortage, if any.

 Parents Signature_________________________________________________

 Date____________________________________________________________    

PLEASE SIGN BACK

GRANTS RECREATION

YOUTH FOOTBALL

 NOTICE TO ALL PATIENTS!

 EXPLANATION OF INSURANCE COVERAGE FOR GRANTS YOUTH FOOTBALL LEAGUE PLAYERS.

 Part of this fee covers insurance.  Each player is covered with Accident/Liability Insurance.

 REMEMBER, it is a $250.00 deductible policy, in other words, the accident must cost in excess of $250.00 before a claim is filed, and if the player’s parents have other insurance, they must file with that first!!!!!!!

 The Recreation Department will provide the forms to fill out and send to the insurance company in New Jersey, but the Recreation Department has no other responsibility.  The Recreation Department cannot actually process the claim! PLEASE REMEMBER THAT!

 It is the Parent’s responsibility to make sure the bills are paid once the insurance claim is filed.  If the insurance is taking to long, it is the Parent’s responsibility to pay a partial payment to the DOCTOR/HOSPITAL in order to keep bills from going to the Credit Bureau.  This is not the Responsibility of the Recreation Department!

 Parents Signature: _______________________________________________________

 Date: ___________________________________________________________________