Rocket Football registration 2013 Final Copy (PDF)

Bangor VikingsRocket Football & Flag Football
Fall 2013Registration Form
Cost: Flag $30.00 Rocket $60.00
Participant’s Name:
Date of Birth:

Shirt Size:
Gender:

Male

League (please circle one)fall of 2013 1st/2nd grade flag football

Age:
Female
3rd/4th grade football

5th/6th grade football

Parent/Guardian name:
Address:
Phone(home):

Email:
(work):

(Emergency):

Any known medical conditions?

Insurance carrier:
Interested in coaching?
Yes
Name:
Grade:___________
Participants may be disciplined for conduct outside of Bangor Community Schools, such as, but not limited to: failing
grades, suspension from regular school activities, fighting, or serious school handbook violations. Lack of effort and or
respect for teammates, coaches and officials may also result in discipline up to and including dismissal from the program.
We expect our parents to encourage the participants to practice good sportsmanship, teamwork, fair play and effort. If
our participants succeed at doing that, they will be winners regardless of the win-loss record. There are also no refunds.
I hereby certify that it is with full knowledge and consent that my child
Participate in the Bangor Rocket or Flag Football program during the 2013 season. I will not hold Bangor Public Schools,
any teams, coaches, managers, sponsors or anyone connected with the conference responsible for death or injury that
my child might sustain in practice, game play or while being transported to and from practices or games. Furthermore I
will not hold anyone responsible for any medical aid administered to my child should they be injured in practice, game
play or while being transported to and from practices or games. While physicals are not required we encourage them.
Parent/Guardian Signature:
Date:
Please return this form and money to Patti Mitchell or Jason Maynard on one of the following registration days; May 4
(9AM-Noon) or May 18 (9AM-Noon) in the Middle School. If you cannot make it one of those days there will be more
throughout the summer. Please make checks out to Bangor Rocket Football.
Jason Maynard 231-414-5210 or jmaynard@bangorvikings.org
Patti Mitchell phorvath@bangorvikings.org
Official use:
Amount paid ________
Date Paid __________
Check #____________