Registration Form

PARTICIPANT'S INFORMATION
Last Name:
 First Name:
 Date of Birth:
 Home Phone:
Address:
 City:
State:
 Zip:
 Height:
 Weight:
Email Address:
 Fall of 2017 Grade:
Fall of 2017 School:

PARENT OR LEGAL GUARDIAN'S INFORMATION
Last Name:
 First Name:
 Home Phone:
 Work Phone:
Address:
 Cell Phone:
City:
 State:
 Zip:
 Relationship:
Email Address:
 Volunteer Position:

PARENT OR LEGAL GUARDIAN'S INFORMATION
Last Name:
 First Name:
 Home Phone:
 Work Phone:
Address:
 Cell Phone:
City:
 State:
 Zip:
 Relationship:
Email Address:
 Volunteer Position:
RISK OF INJURY NOTIFICATION AND RELEASE OF LIABILITY AND PERMISSION ACKNOWLEDGMENT PLEASE READ CAREFULLY
Athletic participation carries with it an increased possibility of injuries, some of which could be serious, such as, but not limited to permanent paraplegia, paralysis and even death. Coaches will utilize current, medically sound conditioning methods and teach only safe, competitive techniques in preparing participants for practices and games. Participants, however, have the responsibility to exercise caution to assure that only approved safe-playing techniques are utilized in practices and games. If unusual or unsafe situations or conditions are observed, I will remove myself from participation and bring such situations or conditions to the attention of the coach or other authorized representative of the organization immediately.
I agree

We/I, the parent(s) or legal guardian(s) of the above participants, do hereby acknowledge that we/I understand the risks in participation, and do hereby grant our son or daughter permission to participate in, the JUNIOR KNIGHTS' FOOTBALL PROGRAM. We/I understand and agree that none of BROOKFIELD ACADEMY JUNIOR KNIGHTS FOOTBALL CLUB, INC., BROOKFIELD ACADEMY, or any of their respective board members, officers, employees, coaches, teachers, administrators, volunteers or representatives may be held liable in any way for any occurrence, including rescue operations, in connection with the program which may result in injury, death or other damages to me or my child, family, heirs or assigns, and in consideration of my child being allowed to participate in the program, we hereby assume all risks in connection with said program and activities related thereto for any harm, injury or damages which may befall me or my child, family, heirs or assigns and further WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, INDEMNIFY AND WARRANT NOT TO SUE BROOKFIELD ACADEMY JUNIOR KNIGHTS FOOTBALL CLUB, INC., BROOKFIELD ACADEMY, and their respective sponsors, board members, officers, representatives, coaches, teachers, administrators, employees, referees, volunteers and agents, any field owners and any opponents (collectively, "releasees") with respect to any and all injury, loss and claim arising from my child's participation in the program, even if due to negligence of the releasees or equipment failure, unless and except that which is the result of releasee's willful and intentional misconduct. This release is signed by the program participant (player) and his or her parent(s) or legal guardian(s) with their consent. We understand that the terms herein are contractual in nature and not a mere recital, and that this release has been signed freely and voluntarily. It is the intent of the signers hereto to exempt, waive, release, discharge, hold harmless, indemnify and warrant not to sue the Brookfield Academy Junior Knights Football Club, Inc., Brookfield Academy, and their respective board members, officers, coaches, teachers, administrators, employees, representatives, volunteers, participants, and agents for any derivative damage caused by anyone's act, error, omission and or negligence.
I agree

EMERGENCY AUTHORIZATION, PHOTOGRAPHIC AUTHORIZATION & TRAVEL RELEASE
EMERGENCY AUTHORIZATION: I hereby give permission to any personnel selected by Brookfield Academy Junior Knights Football Club, Inc. and/or Brookfield Academy to order X-rays, routine medical examinations, tests and/or treatment for the participant named below. In the event I cannot be reached in an emergency, I hereby give permission to the physician or other health care provider selected by the Brookfield Academy Junior Knights Football Club, Inc. and/or Brookfield Academy to hospitalize, secure proper medical treatment for, and to administer necessary medications and/or anesthesia and/or surgery for the participant named below. In the event of an emergency, I expressly release and hold harmless the Brookfield Academy Junior Knights Football Club, Inc., Brookfield Academy, and their respective board members, officers, employees, coaches, teachers, administrators, volunteers, personnel and sponsors for actions taken for the necessary and reasonable medical care on behalf of the participant named below. I also hereby assume personal responsibility for payment of such treatment, understanding that the Brookfield Academy Junior Knights Football Club, Inc. and Brookfield Academy do not provide individual or group health/accident insurance coverage for participants. This form may be photocopied. A photocopy shall be valid as the original.

PHOTOGRAPHIC AUTHORIZATION: I hereby give consent and permission for the participant named below to have his name and likeness displayed on the Brookfield Academy Junior Knights Football Club, Inc.'s website: www.bajrknights.com and any other organizationally approved marketing or promotional materials.

TRAVEL RELEASE: I/WE hereby release BROOKFIELD ACADEMY JUNIOR KNIGHTS FOOTBALL CLUB, INC., BROOKFIELD ACADEMY, and their respective board members, officers, employees, coaches, teachers, administrators, representatives, volunteers and agents from any and all liability and responsibility for providing transportation for our child to and from football games and/or practices for the Fall 2017 football season.
I agree

In the event of accident, sickness, injury, etc, contact the following people in order:
Last Name:
 First Name:
Relationship:
 Home Phone:
 Work Phone:
 Cell Phone:
Last Name:
 First Name:
Relationship:
 Home Phone:
 Work Phone:
 Cell Phone:
Insurance Company:
 Policy #:
 Insurance Phone #:

HANDBOOK ACKNOWLEDGEMENT
The participant and his or her parents recognize and acknowledge by execution below that you have read the Brookfield Academy Junior Knights Handbook in its entirety and agree to the structure and policies and procedures outlined therein.
I agree

MULTIPLE PLAYER DISCOUNT
If you have more than one child participating in the program, check the box below to receive a $25 discount.
Yes, I qualify for the discount.

Please Review Carefully Before Submitting

Brookfield Academy Junior Knights Football Club, Inc. Copyright © 2009. All rights reserved.