2017 DLYF REGISTRATION FORM
(Please circle what you are registering for)
FOOTBALL:
*Braves (12 years and under)
CHEERLEADER: *Braves (5-7 grade)
*Bucks (9-10 years)
*Bucks (3rd-4th grade)
*Tomahawks (6-8 years)
*Tomahawks (1st-2nd grade)
Child's Name:_________________________________
Date of Birth:________________________
Address:_____________________________________
City:_____________Zip:______________
Home Telephone Number:_______________________
Cell Number:________________________
Email Address:________________________________
Grade in 2017 School Year:_____________
Parent/ Guardian Name:_______________________________________________________________
Emergency Contact Name/ Relation:_____________________________________________________
Emergency Phone Number:____________________________________________________________
Allergies:_____________________________________
Pre-existing conditions:________________
___________________________________________________________________________________
REGISTRATION/CONSENT FORM
All rules and requirements for acceptance into the DLYF program are uniform, and are applied and
enforced uniformly without regard to race, color, sex, religion or national origin.
I/We the parent(s)/guardian of the above child give my/our consent to his/her participation during all
DLYF activities. I/We agree to the DLYF requirements of discipline and physical training as necessary
for the chosen activity. I/We agree to hold harmless Deer Lakes Youth Football, Inc. and its members for
any claim arising from injury except for the amount covered by its supplementary accident and health
insurance. I/We as responsible parent(s)/guardian(s), agree to use a family health plan as primary medical
coverage when applicable.
In case of emergency, I/We authorize a licensed physician in attendance, other than our family physician,
Dr.________________________, Telephone_______________, to treat the child named above.
___________________________________________________________________________________
EVERY CHILD MUST BE INSURED
Insurance Carrier: ________________________
Identification No:__________________________
___________________________________________________________________________________
SOCIAL MEDIA CONSENT
I do give/ DO NOT GIVE permission for Deer Lakes Youth Football Inc. to utilize my child's name and/
or picture on the DLYF website and/or social media.
Signature:__________________________________________________________________________
___________________________________________________________________________________
REGISTRATION/ EQUIPMENT/ VOLUNTEER FEES:
First Child: $80 Registration Fee/ $70 Steelers Raffle Tickets
$150
$________
Second Child: $5 Registration Fee/ $40 Steelers Raffle Tickets
$45
$_______
Additional Children: Free Registration Fee/ $20 Steelers Raffle Tickets
$20
$________
Total Due:
$________
Amount:___________Cash:___________Check #:___________ DLYF Initial:___________
Steeler Raffle Ticket Numbers:______________________________________________________
___________________________________________________________________________________
VOLUNTEER/ FUNDRAISING:
Each family will be required to work at the concession stand during 4 homes games, this season. There
will also be mandatory fundraisers, throughout the season. You may either opt out of fundraising or
participate, to have your volunteer/fundraising check returned.
All families are required to submit a post-dated (10/1/2017) check in the amount of $175, that the
organization will return, provided your volunteer time and fundraising has been completed.
All families are required to submit a post-dated (10/1/2017) check in the amount of $250, that the
organization will return upon equipment and uniform turn in
Post-dated Volunteer Check $175
Check #:________
DLYF Initial:________
Post-dated Equipment/ Uniform Check $250
Check #:________
DLYF Initial:________
___________________________________________________________________________________
Cheerleader's Only:
Please circle one of the following sizes, in each line...
Squad Preference:
Recreational Squad
Competitive Squad
Shirt Size:
XS(4-5)
S(6-7)
M(8-9)
L(10-11)
XL(12-13)
1XL(13-14)
2XL(15-16)
Pant Size:
XS(4-5)
S(6-7)
M(8-9)
L(10-11)
XL(12-13)
1XL(13-14)
2XL(15-16)
Football Player’s Only:
Please circle one of the following size shirts, for your child…
Youth XS
Youth S
Youth M
Adult S
Adult M
Adult L
Youth L
Youth XL