Football Registration

What Level Are You Registering For?^*

Email^*

Enter email again^*

Parent/Guardian's Name:^*

Parent/Guardian's Contact Number:^*

Is Your Child a Returning Participant?^*

Child's Name:^*

Child's Date Of Birth:^*

Child's Gender:^*

Child's School Attending:^*

Child's Grade (While Participating in the Program):^*

Emergency Contact's Name:^*

Emergency Contact's Number:^*

Emergency Contact's Relationship to Child:^*

Is this child allergic to any medications?

Does this child have any medical history that you feel we should know about?

The following information is confidential and will be used solely for future program and funding opportunities.

Child Lives With:^*

Both Parents
Mother Only
Father Only
Legal Guardian

Consent and Release:^*

My child/legal ward has permission to participate in Premier Athletics for Youth Development programs. I hereby release and wave any and all claims against Premier Athletics for Youth Development and any agents, representatives, officers, board of directors, coaches, and other personnel of the same; from any responsibility of liability or liability for any injury, loss or damage which may hereafter be suffered or sustained by my child arising out of their playing or participating in this program. This includes but is not limited to competing in sports, traveling to or from any games/events, practice, or activities sponsored by Premier Athletics for Youth Development or while a spectator at any games, practices, or events. I authorize the head coach of my child’s team, Premier Athletics for Youth Development staff, or emergency personal to seek and/or provide medical attention for my child if I cannot be contacted.

I have read and accept the terms within the consent and release.

Model Photo Release:^*

I, for good and valuable consideration, the receipt of which is hereby acknowledged, hereby irrevocably authorize Premier Athletics for Youth Development to use photographs of me, my child, and/or my property and authorize their assignees, licensees, legal representatives and transferees to use and publish (with or without me or my child’s name, company name, or with fictitious name) photographs, pictures, portraits or images herein described in any or all forms and media and in all manners including composite images or distorted representations, and the purposes of publicity, illustration, commercial art, advertising, publishing (including publishing in electronic form in DVDs or internet websites), for any product or services, or other lawful uses as may be determined by Premier Athletics for Youth Development. I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I am of full legal age and have read and fully understand the terms of this release. I am the parent or guardian of the minor named above. I have the legal rights to consent to and do consent to the terms and conditions of this model release.

I have read and accept the terms of the Model Photo Release.

Parent Code of Conduct:^*

Premier Athletics for Youth Development (PAYD) provides a safe and balanced learning environment for players of all abilities that develops athletic skills, character, sportsmanship, and teamwork for Kalamazoo area school children through their participation in youth sports. It is therefore essential for parents, coaches and officials to encourage youth athletes to embrace the values of good sportsmanship. Moreover, adults involved in youth sports should be models of good sportsmanship and respect, and should lead by example by demonstrating fairness, decency, and self-control. As a parent or guardian of a PAYD player, I therefore pledge to be responsible for my (and other any parent, guardian or guests of my child) words and actions while attending or participating in a youth sports event and shall conform my behavior to the following Code of Conduct: 1. I will remember that children participate to have fun and that the game is for the youth participants, not adults. 2. I (and my guests) will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy, and by demonstrating positive support for all players, coaches, officials and spectators at every game, practice or other sporting event. 3. I (and my guests) will not engage in any kind of unsportsmanlike conduct with any official, coach, player, or parent such as booing and taunting; refusing to shake hands; verbal or physical threats; or using profane language or gestures. 4. I will not engage or encourage my child or any other person to engage, in any behavior which would endanger the health, safety or well-being of any coach, parent, player, participant, official or any other attendee. 5. I will treat, and insure my child treats, any coach, parent, player, participant, official or any other attendee with respect regardless of race, creed, color, national origin, sex, sexual orientation, game play or ability. 6. I will not initiate and will not tolerate my child initiating a verbal or physical fight, abuse, negative comments or scuffle with any coach, parent, player, participant, official or any other attendee. 7. I will not embarrass my child by calling attention to him/her through loud or rude behavior. 8. I will encourage my child to practice good sportsmanship. 9. I will never ridicule or yell at my child or other participant for making a mistake or losing a competition. 10. I will promote the emotional and physical well-being of all the athletes ahead of any personal desire I may have for my child to win. 11. I will respect the officials and their authority during games and will never question, discuss, or confront coaches at the game, and will take time to speak with coaches privately at an agreed upon time and place if I have an issue or concern. I hereby agree that if I (or other parent, guardian, or guests of my child) fail to conform my conduct to the foregoing while attending, coaching, or participating in a PAYD youth sports event I and/or my child will be subject to disciplinary action, including but not limited to the following in any order or combination: 1. Verbal warning issued by the league, PAYD organization or an PAYD official who is authorized to issue such warning. 2. Written warning issued by the league, PAYD organization or a PAYD official who is authorized to issue such warning. 3. Suspension or immediate ejection from a PAYD event issued by the league, PAYD organization or a PAYD official who is authorized to issue such suspension or ejection. 4. Suspension from multiple PAYD events issued by the league, PAYD organization or a PAYD official who is authorized to issue such suspension. 5. One season, multiple season or permanent suspension issued by the league, PAYD organization or a PAYD official who is authorized to issue such suspension. 6. Requirement to provide written and/or in person explanation of a failure to conform to the conduct outlined above with the League Director, PAYD organization, or a PAYD official. Consequences of Behavior At any PAYD event, practice, or competition; any adult who verbally abuses, attempts to intimidate, is flagrantly rude to, or does not control their language or actions with a player, official, coach, spectator, or PAYD official, will be asked to leave the event. He or she will receive a verbal warning regarding their behavior. IF THE SPECTATOR FAILS TO LEAVE UPON REQUEST, LAW ENFORCEMENT AUTHORITIES WILL BE CALLED TO REMOVE THE SPECTATOR. Any spectator that has to be removed in this manner WILL BE PERMANENTLY BANNED from any and all future PAYD events, practices, competitions, or events.

I acknowledge, by checking here, that this PAYD Code of Conduct agreement may be updated and modified at PAYD’s sole discretion from time to time. And, by checking here, I understand and agree to abide by all the provisions and restrictions contained within this PAYD Parent Code of Conduct agreement.

Please note: Any uniforms or protective gear that is provided by the Premier Athletics must be returned in good condition at the end of the season. Uniforms are defined as the following: Jerseys, football pants with pads, and/or singlets. Protective gear is defined as the following: Helmets, shoulder pads, and/or cleats.