Download page

2009 sign up form

Northern Independent Athletic Association/Football (N.I.A.A.) Columbus, Ohio 43224 2009 Application for Football & Cheerleading Child’s name: _____________________Age:_____Home phone___________ First Last Address: _________________________City:______________Zip:_________ Age:______Birth date:___________School:_______________Grade:________ Entering in fall Parent/Guardian Information: Cell phone:______________ First Name:____________________Last Name:____________________Home Phone:______________ Address:____________________________________________________________________________ Street City Zip Emergency Contact Person:_______________________________________Phone#_________________ Is your child? Male____ or Female____ Does your Child need any special assistance____yes____no if yes, please specify____________________________________________________________________ ___________________________________________________________________________________ You must at least pay $25.00 deposit at time of sign-up. Football fees $75.00, Drill team $75.00, Cheerleading fees $165.00 for returning girls $285.00 for new girls . Payment plan add $5.00($25.00 non-refundable deposit) due at sign up, half the balance due by the June18th, Final balance due July16th. All fees are non-refundable 7 day after your sign up date. All deposits are non-refundable. Fees paid later than July 16th will have a $10.00 late fee added on Acknowledgment of Risks, Liability Release and Indemnification Agreement In signing this release for myself and for any named participant (if such participants under age 18), I acknowledge and understand that, as a participant in N.I.A.A. Football/Cheerleading programs, children and adults may be exposed to RISKS OF SERIOUS BODILY INJURY, SICKNESS, OR DEATH due to the circumstances inherent in little league sports programs, including the negligent acts or omissions of others. I ACKNOWLEDGE that there are a variety of risk and dangers inherent in recreational activities and facilities, including but not limited to: sports-related injuries; collisions with stationary objects; falls; adverse environmental conditions or any other conditions which may cause heatstroke, heat exhaustion hypothermia or any other illness or injury; physical contact between participants, injuries related to overexertion, slippery surfaces misuse or inexperience with the program equipment. In exchange for being permitted to participate, I voluntarily agree to assume all of these and other risks inherent in participating in such recreational activities and facilities. I acknowledge that I (or the participant for whom I sign, if under 18 years of age) have/has no physical limitations, or disabilities of any kind which would restrict anyone from participating. Any special accommodations needed have been noted above. Despite these dangers, and in consideration of the N.I.A.A. accepting my registration. I for myself and/or the participant, all heirs, executors, administrators and assigns, AGREE TO HOLD HARMLESS AND RELEASE the N.I.A.A., its board trustees, officers, volunteers, and other representatives, coaches, referees, and the city of Columbus FROM ALL CLAIMS FOR LIABILITY OR LEGAL RESPONSIBILITY FOR ANY DAMAGES OR LOSS OF ANY KIND, including PERSONAL INJURY OR DEATH, PROPERTY DAMAGE, AND ECONOMICAL LOSS, arising from my participation in N.I.A.A. football and cheerleading or use of the city of Columbus Cremeans park, Huy Park, and Whetstone High School. I further, on behalf of myself or the minor for whom I am signing, agree to PROTECT AND HOLD HARMLESS the Northern Independent Athletic Association and the listed persons and entities FOR ANY AND ALL COST, LIABILITY, EXPENSE AND CLAIM arising form any act or omission committed by myself or the named participant related to the N.I.A.A. Football/Cheerleading programs or any other activity or program of the N.I.A.A. I further agree that in the event that my child repudiates or attempts to reduplicate such release, I will indemnify and save harmless the N.I.A.A., its successors and assigns, for any and all loss and damage occasioned thereby. I HAVE READ AND AGREE TO THE TERMS OF THIS RELEASE WAIVER. _______________ ____________________________________________________________________ Date Signature of the custodial Parent or Guardian ___________________________________________________________________________________________________________________ For league use only Received By ___________ Fees Paid______ ______Birth Certificate_____________Equipment Rental Date_______________ Payment Plan________ Deposit__________ 1st payment___________ Last payment___________

Equipment rental form

Northern Independent Athletic Association/Football (N.I.A.A.) Columbus, Ohio 43224 2009 Football Equipment Rental Form Child’s name: __________________________Age:_____ --- ______ Lbs Team First Last Address: _________________________ City:______________ Zip:_________ Parent/Guardian Information: Cell phone:______________ First Name:____________________Last Name:____________________Home Phone:______________ Address:____________________________________________________________________________ Street City Zip Does your Child need any special assistance____yes____no if yes, please specify_________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 55.00 EQUIPMENT RENTAL WITH A 25.00 REFUND WHEN RETURN COMPLETE. ( NO FULL REFUNDS ANYTIME FOR ANY REASON ) REPLACEMENT PARTS FOR ---HELMET 25.00, HELMET PADS ARE 2.00, SCREWS 1.00 -- SHOULDER PAD 25.00, SHOULDER PAD STRAPS 1.00, CLIPS 1.00 EACH --- CHIN STRAP 4.00, CLIPS 1.00 ---- PANTS PAD 1.00 EACH Acknowledgment of Risks, Liability Release and Indemnification Agreement In signing this release for myself and for any named participant (if such participants under age 18), I acknowledge and understand that, as a participant in N.I.A.A. Football/Cheerleading programs, children and adults may be exposed to RISKS OF SERIOUS BODILY INJURY, SICKNESS, OR DEATH due to the circumstances inherent in little league sports programs, including the negligent acts or omissions of others. I ACKNOWLEDGE that there are a variety of risk and dangers inherent in recreational activities and facilities, including but not limited to: sports-related injuries; collisions with stationary objects; falls; adverse environmental conditions or any other conditions which may cause heatstroke, heat exhaustion hypothermia or any other illness or injury; physical contact between participants, injuries related to overexertion, slippery surfaces misuse or inexperience with the program equipment. In exchange for being permitted to participate, I voluntarily agree to assume all of these and other risks inherent in participating in such recreational activities and facilities. I acknowledge that I (or the participant for whom I sign, if under 18 years of age) have/has no physical limitations, or disabilities of any kind which would restrict anyone from participating. Any special accommodations needed have been noted above. Despite these dangers, and in consideration of the N.I.A.A. accepting my registration. I for myself and/or the participant, all heirs, executors, administrators and assigns, AGREE TO HOLD HARMLESS AND RELEASE the N.I.A.A., its board trustees, officers, volunteers, and other representatives, coaches, referees, and the city of Columbus FROM ALL CLAIMS FOR LIABILITY OR LEGAL RESPONSIBILITY FOR ANY DAMAGES OR LOSS OF ANY KIND, including PERSONAL INJURY OR DEATH, PROPERTY DAMAGE, AND ECONOMICAL LOSS, arising from my participation in N.I.A.A. football and cheerleading or use of the city of Columbus Cremeans park, Huy Park, and Whetstone High School. I further, on behalf of myself or the minor for whom I am signing, agree to PROTECT AND HOLD HARMLESS the Northern Independent Athletic Association and the listed persons and entities FOR ANY AND ALL COST, LIABILITY, EXPENSE AND CLAIM arising form any act or omission committed by myself or the named participant related to the N.I.A.A. Football/Cheerleading programs or any other activity or program of the N.I.A.A. I further agree that in the event that my child repudiates or attempts to reduplicate such release, I will indemnify and save harmless the N.I.A.A., its successors and assigns, for any and all loss and damage occasioned thereby. I HAVE READ AND AGREE TO THE TERMS OF THIS RELEASE WAIVER. _______________ ____________________________________________________________________ Date Signature of the custodial Parent or Guardian ___________________________________________________________________________________________________________________ For league use only Received By ___________ Fees Paid______ ______Birth Certificate_____________Equipment Rental Date_______________ Helmet size_____ Chin Strap Color / Type_______ Shoulder Pads Size________ Pad Set________