OTRD’s Gridiron Club (Youth football) (208) 678-6879 Email: [email protected]

ONE PLAYER PER FORM Fee $65.00 district members $70.00 non-members Last Day (Please make checks payable to: OTRD) to Sign Up Register and Pay Online @ www.otrd.org 7/18/2021 -or- Drop Form and Payment off at Hat N Sole or @ OTRD Rec Center Sign up by May 31st Players :______$5 Off

Grade (2021/2022 school year):______Birth Date: _____/_____/______School: ______Shirt sizes

Grade (circle one): 3rd 4th 5th 6th *No 3rd grade team (Circle one)

YS 6-8 Parent/Guardian’s Names: ______YM 10-12 Address: ______City:______State:____ YL 14-16

Home Phone: ______Mom Cell: ______Dad Cell:______Zip______AS AM Email:______AL

AXL

Do you want to Coach? Yes No (Circle One) Do you want to Assistant Coach? Yes No (Circle One)

Will you or your employer sponsor a team? Yes No (Circle One)

Gold Sponsor: $500 (Name game jerseys) Silver Sponsor: $200 (Team Banner & Banner) Bronze Sponsor: $100 (Team Banner)

Name of Sponsor: ______

AGREEMENT, WAIVER AND RELEASE: In consideration for allowing my child or legal ward to participate in the above OTRD activity, I DO HEREBY WAIVE, RELEASE AND FOREVER DISCHARGE THE OTRD, their agents and assigns from all liability, claims or demands on account of any injury to said minor or damage to or loss of property while traveling to, participating in or attendance at any OTRD activity. It is my understanding that there is no insurance coverage provided by the OTRD and ALL PARTICIPANTS ASSUME THE RISK OF ACCIDENTS AND INJURIES inherent in OTRD activities. I also, give permission to Oregon Trail Recreation District, sponsors, and partners to use my likeness, photo, video, name, voice, and words in the newspaper, website or appear in any public forums.

I understand that OTRD permits the participants to use the equipment at no charge. I agree to maintain and return the equipment in the same condition as it was issued (except for normal wear and tear). The League reserves the right to determine the status of said equipment. I also agree that in the event any of the equipment is not returned by the at the end of the season, I am held responsible for the entire cost of the equipment.

Signature ______Date ______

(ONLY A PARENT OR LEGAL GUARDIAN MAY GIVE PERMISSION FOR A CHILD TO PLAY)

IF there is room on a team and we have already ordered jersey’s there will be a $25 Late Fee added on. Cash OTRD will not honor or accept team or player placement request. Exception: coach or assistant coach’s child. Check # ______