Rocket Football registration 2014 Final Copy (PDF)

Bangor Vikings Rocket Football & Flag Football
Fall 2014 Registration Form
Cost: Flag $30.00 (Includes use of flags and a jersey your athlete will keep) Rocket $60.00

(Includes use of

helmet, shoulder pads, pants, mouthpiece and a jersey your athlete will keep)

Participant’s Name:
Date of Birth:

Shirt Size:
Gender:

Male

League (please circle one) fall of 2014 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 2014 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: June 16, July 7 and July 21 in the middle school from 3:30-5:30. If you cannot make it one of those
days please call or email and we can make an arrangement.
Jason Maynard 231-414-5210 or jmaynard@bangorvikings.org
Patti Mitchell phorvath@bangorvikings.org
Official use:
Amount paid ________
Date Paid __________
Check #____________