Symbolic Art Flag Football Developmental Program
Boys & Girls, 1st - 8th Grade

All youth participants especially those at the middle school level are required to show weekly progress reports and grades when available. Symbolic Art staff and coaches encourage young players to maintain good grades and help them learn how to improve in the areas of citizenship, social responsibility and accountability. The next 8 week flag football session : Mar 14th - May 2nd

The following are Symbolic Art Middle School Sites:

• Becker Middle School *9151 Pinewood Hills Dr.  *All Games Played @Becker's Field Saturdays beginning Mar 14th through May 2nd; 10am - 2pm

• Molasky Middle School *7801 W. Gilmore Ave
• Johnson Middle School *7701 Ducharme Ave

Open Registration: Mar 2, 2015 - Mar 21, 2015

Returning Players: $45

New Players:

•  $65 registration fee covers the 8 week session and includes a team t-shirt
• $32.50 registration fee covers a 4 week session and includes a team t-shirt

Elementary School Players

*Practice times are held at recess at each participating elementary school

• Richard H. Bryan Elementary ~ Tuesdays
• William Lummis Elementary ~ Thursdays

*Current Session Ends April 4th: Saturday Games Are Played at 10am - 10:45am

**Next Session Begins April 11th - May 23rd ~ Registration Opens: March 28th

Note: Athletes Must Wear Sport's Attire to Include: Mouthpiece & Cleats

SKILLS DEVELOPMENT | CONDITIONING | AGILITY | TEAMWORK

More Info RE: Practice, Game Times ~ Please Contact
Coach Dwayne McIntyre via Email

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This Form cannot be submitted until the missing fields (labelled below in red) have been filled in

Symbolic Art Flag Football Developmental Program at Becker MS Field

Please note that all fields followed by an asterisk must be filled in.

Participant's Name*

Participant's Date of Birth*

Insert the Name of Participant's School*

Participant's Sibling(s) Name & Date of Birth N/A if Not Applicable*

Insert the Name of Sibling's School (If Applicable)

Parent or Guardian's Name*

Name & Phone # of the Person Who Receives Text*

Last Name*

E-Mail Address*

Street Address*

City*

State/Prov*

Zip/Postal Code*

Home Phone*

Business Phone*

Emergency Contact Name & Relationship*

Emergency Contact Phone*

Child May Be Picked Up By (Someone other than parent/guardian)*

Name, Relationship & Phone No. of the Alternate Person (other than parent/guardian)*

Have You Participated in Other Symbolic Art Events?*

Yes No

Allergies or Special Needs? N/A if not applicable*

Shirt Sizes *Indicate 'Youth or Adult' *

How Did You Hear About SA Flag Football?*

Fee Disclosure*

Registration fees are required prior to participating in any Symbolic Art practice and/or games - Online registration fees include: $5 online processing fee. Payments will be accepted in cash, money order, or credit card. Payments will only be accepted from adults listed on this form.

Sign-In & Sign-Out*

To protect the safety of our children I understand each child must be signed in (checked-in) and checked-out of our program. The only person(s) authorized to pick up the child(ren) are those listed on this form; photo ID must be shown. Children "will not" be released without proper identification "and" prior written authorization from enrolling parent/guardian. *Authorization via Email is acceptable. In the case of joint custody disputes - Symbolic Art staff will comply "Only" with "Written" instructions directed by court order on file with Symbolic Art (if applicable)

Waiver of Claim*

For ourselves, and/or on behalf of our child named above, our heirs, executors, and administrators, we hereby do expressly and forever waive and release Symbolic Art, and their respective officers, employees, coaches, agents or representatives from any and all liability for personal injury or damages, sustained, incurred, arising from or connected with travel to, or return from any and all events and activities related to, or in connection with said activity by ourselves or by our child. *Symbolic Art is a community based organization focused on making sports, recreation and artistic expression fun for youth ages 4-16. During programs or events sponsored by Symbolic Art - staff may take photos of participants that may be used in professionally designed publications and promotional materials.

Sports Waiver*

1.) The undersigned agrees that participant voluntarily participates in playing sports and fitness i.e. Flag Football, Basketball, Soccer, TaeKwonDo, and assumes all risks associated with such activity. 2.) The undersigned acknowledges that there are risks and hazards associated with participating in sports & fitness programs to include, but not limited to those caused by court/field conditions, playing conditions, equipment and other participants. Additionally, there are certain inherent physical risks associated with the acts of dribbling, passing, shooting, dunking a basketball, running, jumping, stretching, sliding, diving and collisions with other players, spectators, or stationary objects, any of which may cause death or serious injury. 3.) While Symbolic Art carries general liability insurance which primarily covers damage to facilities, all players are required to show proof of health insurance before he/she will be allowed to participate in Symbolic Art Sports & Fitness i.e. basketball, soccer, TaeKwonDo 4.) In consideration of the Clark Co. School District (CCSD) allowing Symbolic Art activities to be played in areas owned, operated, or leased by the CCSD, I AGREE TO INDEMNIFY AND HOLD HARMLESS AND RELEASE Symbolic Art, CCSD, and their officials, employees, agents and assigns from any and all liability for personal injury or damages sustained, incurred, arising from or connected with travel to, return from any and all classes, tournaments and/or special events, and all activities related to, or in connection with said activity by ourselves or by our child. I further release all claims, demands, lawsuits, costs and attorneys fees arising out of playing in the Symbolic Art program associated with this waiver. Symbolic Art staff may take photos of participants that may be used in professionally designed publications and promotional materials. This release and Indemnification shall be effective and bind any and all heirs, dependents, executors, and assigns. 5.) I ACKNOWLEDGE THAT I HAVE THE RIGHT AND OBLIGATION TO INSPECT the courts, fields and surrounding areas prior to each game, practice or activity and agree to participate in the “as is” condition. If I find the courts, fields and surrounding areas are not safe, I have the right to choose not to participate. 6.) I acknowledge that I have read the foregoing instrument and understand its terms and agree to abide by its terms and conditions.

Please Type Your Name *