OAKLYN COUGARS ONLINE REGISTRATION

Please fill this form out in it's entirety...

Participant Information:

First Name                                   

Last Name                        

Parent/Guardian Full Name(s)     

Date of Birth                     January February March April May June July August September October November December     1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Current Weight (Football only)   

Address                          

City                             

State                             NJ PA

Zip code                         

Phone Number                     

School                           

Grade in Fall 2008               

In case of emergency notify...   

Phone Number                     

Family Doctor                    

Insurance Carrier                

Insurance Policy                 

(If applicable)

In your own words describe any health

conditions or allergies problems. 

Terms and Conditions:

I hereby authorize my son/daughter to participate in Oaklyn Cougar Midget Football or Cheerleading.  It is my understanding that the Oaklyn Cougar Midget Football Association has purchased "Full Excess" accident insurance coverage for all sports.

Oaklyn Cougar Midget Football Association desires to protect parents from financial burdens which can result form accidents while participating in sports.  All bills are to be submitted through the parents insurance carrier first.  "Full Excess" means that the insurance company shall not include that portion of medical expense resulting from any covered injury that is reimbursable by other valid and collectible insurance.  Our insurance carrier will cover excess expenses for treatment within 365 days of the initial accident, and up to $250,000.00 for each accident.

I hereby acknowledge that there are certain risks of personal injury inherent in participating in the sport listed on this registration form for which the Oaklyn Cougar Midget Football Association cannot bear liability.  Accordingly, by accepting these terms and conditions and providing a VALID e-mail address which will act as my electronic signature, I release the Oaklyn Cougar Football Association from liability in regards to personal injuries occurring form those inherent risks.

I agree and accept

Electronic Signature Required (Valid E-Mail Address)