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Garfield Youth Sports 2024 Football & Cheerleading Registration Form

Brothers and Sisters Emerging After-School and Mentoring Program.

Baby Twerps (5-6years old) Twerps (7-8 years old) Termites (9-10 years old) Mighty Mites (11-12 years old) Midgets (13-14 years old)

NOTE to Football Players: Baby Twerps can turn 7 after June 1st Twerps can Turn 9 after June 1st, Termites can turn 11 after June 1st, Mighty Mites can turn 13 after June 1st, and Midgets can turn 15 after September 1st, but can’t be beyond 9th Grade

Email Address *

For FOOTBALL participants, please select the team you are registering forTwerps (7-8 years old)Termites (9-10 years old)Mighty Mites (11-12 years old)Midgets (13-14 years old)Baby Twerps (5-6 Years old)

For CHEERLEADING participants, please select the team you are registering forTwerps (7-8 years old)Termites (9-10 years old)Mighty Mites (11-12 years old)Midgets (13-14 years old)Baby Twerps (5-6 Years old)

Select all that apply to Child: *Participated in the 2023 G.Y.S. Football ProgramParticipated in the 2023 G.Y.S. Cheerleading ProgramIs a new Football ParticipantIs a new Cheerleading Participant

Child's First and Last Name *

Neighborhood *

School/Grade in 2024-2025 *

Date of Birth *

Age as of 06/01/24 *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

T Shirt Size *Youth XSYouth SmallYouth MediumYouth LargeYouth XLAdult XSAdult SmallAdult MediumAdult LargeAdult XL

Home, Work, and Cell Phone *

Does your child receive Free or Reduced Lunch in School? *YesNo

Do we have permission to take and use pictures of your child for the purposes our organizational marketing and its communications? *YesNo

Acknowledgement *

Football Parents: All equipment remains the property of Garfield Youth Sports. By signing this form, parent or guardian hereby acknowledges that he or she will assume liability for any equipment of participant’s that is lost or stolen. Cheerleader Parents: All uniforms remain the property of Garfield Youth Sports. By signing this form, parent or guardian hereby acknowledges that he or she will assume liability for any uniforms of participant’s that is lost or stolen.

Informed Consent & Release of Liability *

I herewith give my permission for the above participant to engage in the 2024 Football and Cheerleading program coordinated by Garfield Youth Sports and do further release, absolve, indemnify and hold harmless Garfield Youth Sports, its coaches, organizers, sponsors and supporters from any and all liability for any claim or claims arising from any injury or injuries which may befall my child in the course of his/her involvement in any practices or games arranged by Garfield Youth Sports. If I am unable to transport my child to games connected with the program, I herewith give my consent to Garfield Youth Sports to arrange for and provide such transportation. Furthermore, I give permission to Garfield Youth Sports / Brothers and Sisters Emerging to share information on my child with funders, emergency care providers, counselors, medical professionals, schools, and other human service agencies on an as-needed basis. All information will be kept strictly confidential.
IF YOU ACCEPT THESE TERMS AND CONDITIONS TYPE YOUR FULL NAME AND TODAY'S DATE INTO THE ANSWER BOX BELOW TO SERVE AS YOUR ELECTRONIC SIGNATURE

Signature *

Start signing your signature here

How would you prefer to pay the registration fee? *Ca$hApp: $GarfieldGators94CheckCashOther(Ca$hApp is preferred by BASE) use: https://cash.app/$GarfieldGators94 to submit registration fee.

If you are paying with Ca$hApp please include your CashApp username/email. If you are not please write N/A *

Garfield Youth Sports 2024 Football & Cheerleading Medical Form

Brothers and Sisters Emerging After-School Garfield Gators and Gatorettes, and Mentoring Programs.

Email Address *

Prefix

Child's First Name

Middle Name

Child's Last Name

Date of Birth *

Age *

Parent/Guardian's Name *

Emergency Contact Name/Relation *

Phone *

Family Doctor's Name *

Family Doctor's Phone *

Family Doctor's Address *

Health Insurance Provider *

Group # (Optional: Only in case of emergency)

Does your health insurance have any special instructions in case of emergency that we should be aware of if you are not immediately available?YesNo

If yes, explain:

CHILD’s HISTORY: Does your child currently have any of the following OR has your child ever been diagnosed with any of the following? **Asthma*ConcussionBleeding TendenciesRheumatic DiseaseSpinal DiseaseKnee ProblemsCovid 19AllergiesBronchitisFracturesPneumoniaAnemiaBone DiseaseNone

Does your child take any routine medications? Answer YES or NO. If YES, Describe: *

Does your child have any physical handicaps? Answer YES or NO. If YES, Describe: *

Any problems with vision or hearing? Answer YES or NO. If YES, Describe: *

Any unusual shortness of breath? Answer YES or NO. If YES, Describe: *

Any recent weight changes? Answer YES or NO. If YES, Describe: *

Do you agree with the following statement: "I feel that my child is physically fit to participate in calisthenics and contact practice, scrimmages, and games and I shall not hold the Garfield Youth Sports (GYS) football and/or cheerleading program coaches, or organizers responsible for any problems arising because of a previous health problem or injury?" *YesNo

Signature

Sign here

Parent or Guardian, please provide your electronic signature in the box above. By signing and submitting this form you agree to the statement above and attest that all information provided herein is accurate and correct.

CONTACT US

(412) 404-2250

5315 Hillcrest Street Pittsburgh, PA 15224

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Our endeavor is to create community environments where cycles of social, emotional, educational, and economic disparities are broken

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