FOOTBALL CLUB 2015 Season ______________________________________________________________________________________________________________

Dear Parents: Hope this letter finds everyone enjoying the wonderful winter we have had! Can you believe it’s time to think about Shelby Lions’ football again? Once again, we are proud to welcome back your children to be part of one of the greatest youth football organizations in the country! This will be another exciting season!

Return Registration is the opportunity for any child enrolled last season to register for a spot on the appropriate team/squad they should be on this season according to their age/weight. Our rosters fill very quickly--please take advantage of Return Registration. If you choose not to attend Return Registration, you will need to register at Open Registration. If there are openings on rosters at Open Registration, they are filled on a lottery basis. Open Registration for football and cheer is scheduled for Tuesday, March 3, 2015.

Our program outline: FOOTBALL PROGRAM: 3 full weeks of conditioning instruction (M-F); 3 days/week practice (T, W, Th) once season begins (with Fridays optional); 8 Games (4 Home/4 Away). 2 OMYFA Playoff Games, Flag Bowl Game, and Super Bowl. Club events: Parents’ Day, Banquet, Trophy and Yearbook, including the use of club equipment/uniform required. Everyone gets guaranteed playing time, positive coaching, good sportsmanship, and there’s lots of FUN!! CHEERLEADING PROGRAM: 3 full weeks of conditioning instruction; 3 days/week practice (T, W, Th) once season begins. 8 Games (4 Home/4 Away). 2 OMYFA Playoff Games, Flag Bowl Game, Super Bowl and Cheer Off. Club events: Parents’ Day, Banquet, Trophy and Yearbook, including the use of club equipment/uniform required. The OMYFA Cheer-Off is a mandatory event with the possibility of additional practices.

ALL PAPERWORK AND FEES ARE REQUIRED AT THE TIME OF REGISTRATION IN ORDER TO BE PLACED ON A ROSTER — NO EXCEPTIONS.

Please make sure that you bring the completed Registration form, Emergency/Medical Information sheet, signed Parent’s Consent, Liability Waiver, Refund Policy, Athletic Consent form, Parks & Recreation form, a copy of birth certificate, one (1) current picture of your child, and fees. PLEASE ALSO BRING your child(ren), as tackle football players MUST be present for weigh-in by the GM and to be fitted for their helmets and girdles. Cheerleaders MUST be present to be fitted for their warm-ups. Coaches will also be on hand to assist in team placement.

The first day of practice is Monday, August 10, 2015.

Again, physicals ARE required for all participants and must be dated after April 15, 2015. The Physical form is attached with this packet and must be completed and dated by a physician, mailed to the P.O. Box and on file with the Club Secretary on or before July 1st. If no physical is on file, your child will not be put on the roster, given equipment, or allowed on the practice field. This must be enforced in order to adhere to the standards of the OMYFA insurance requirements.

Our MANDATORY PARENT NIGHT, which is necessary for ALL PARENTS OF PARTICIPANTS, will tentatively be held Tuesday May 6, 2015. Parent Night is a time for introductions, an overview of the upcoming season, a question/answer session, as well as volunteer expectations/sign-ups. If you are not in attendance on this evening, YOU will be responsible for obtaining any information you missed. Parent Night is also a great opportunity to check-out new Shelby Lions merchandise!

We truly appreciate your support and look forward to seeing you at the registration night!

MARCH 3rd return registration

MARCH 24th open registration

The Officers, Board Members, and Coaches of

THE SHELBY LIONS FOOTBALL CLUB

WHO: RETURNING PLAYERS/CHEERLEADERS

WHEN: TUESDAY, MARCH 3, 2015 from 7:00 p.m. – 8:30 p.m.

WHERE: Local 400 UAW 50595 Mound Rd, Utica, MI 48317

OFFICERS:

ED GEHLE President

ROB PARKE Vice-President

OPEN Treasurer

BARB ROEK Secretary

DOMENIC GUADAGNINO General Mgr -Football

BRENDA MURPHY General Mgr-Cheer

BOARD MEMBERS:

Pete Agnello

Chris Alverson

Jason Bird

Sal Cucchiara

Brenda Dries

Al Jakubowski

Jim Jennings

Jason Mlynarek

Marcia Walters

HEAD COACHES:

Phil Park, Flag

Robert Dueweke, Freshmen

Jim Seeling, JV

Doug Stedtefeld, Varsity

 SHELBY LIONS FOOTBALL CLUB  P.O. Box 182215  Shelby Twp., MI  48318 

www.ShelbyLions.com

OAKLAND MACOMB YOUTH FOOTBALL ASSOCIATION SHELBY LIONS

2015 REGISTRATION FORM _________________________________________________________________________________________

PARTICIPANT INFORMATION PARENT INFORMATION NAME ____________________________________ MOTHER’S NAME ___________________________________ ADDRESS _________________________________ EMERGENCY # _____________________________________ CITY & ZIP _________________________________ FATHER’S NAME ___________________________________ PHONE # __________________________________ EMERGENCY # _____________________________________ BIRTHDATE ________________________________ 1st E-MAIL ADDRESS AGE ON NOVEMBER 1, 2015 __________________ __________________________________________________ GRADE DURING SEASON _____________________ 2nd E-MAIL ADDRESS WEIGHT ___________ SQUAD ________________ __________________________________________________

SCHOOL __________________________________ DOCTOR’S NAME ___________________________________ HAVE YOU EVER PLAYED YOUTH FOOTBALL FOR DOCTOR’S # _______________________________________ A CITY OTHER THAN WHO YOU ARE NOW Y N REGISTERING FOR? IF YES, PLEASE LIST THIRD PARTY EMERGENCY CONTACT THE CITIES __________________________ NAME ____________________________________________ Y N Y N RELEASE NEEDED COPY ATTACHED PHONE ___________________________________________ [Preferred placement of athlete picture]

REGISTRATION FEES: Family raffle is NOT paid on-line. It is collected only once per family, please bring to registration night) FLAG Football $180.00 TACKLE Football $280.00 FLAG CHEERLEADING $205.00 CHEERLEADING $255.00 *Family Raffle $100.00 *Family Raffle $100.00 *Family Raffle $100.00 *Family Raffle $100.00 TOTAL $280.00 TOTAL $380.00 TOTAL $305.00 TOTAL $355.00

PLEASE MAKE CHECKS PAYABLE TO: THE SHELBY LIONS FOOTBALL CLUB *Family Raffle--10 tickets, which are $10.00 each; you may choose to sell them. Three (3) tickets will be drawn per home game for cash prizes. All tickets then go back in for next week’s drawing and so on until the last home game. This is the Club’s main

fundraising effort and has been a great success. Additional tickets may be purchased prior to the first drawing. Thanks for your support! ___________________________________________________________________________________________________

REQUIRED REGISTRATION PAPERWORK REGISTRATION FORM ATHLETIC CONSENT FORM RELEASE OF LIABILITY FORM MEDICAL TREATMENT FORM BIRTH CERTIFICATE CURRENT PICTURE FEE PHYSICAL (Dated after 4/15/2015)

BIRTH

CERTIFICATE

MICHIGAN HIGH SCHOOL ATHLETIC ASSOCIATION, INC.

MEDICAL HISTORY • To be completed by parent or guardian or 18-year-old.

• Must be signed below by parent or guardian or 18-year-old.

A CURRENT-YEAR PHYSICAL IS ONE GIVEN ON OR AFTER APRIL 15 OF THE PREVIOUS SCHOOL YEAR

 

LAST FIRST MI

STUDENT’S NAME: SEX GRADE DATE OF BIRTH

--- --- AGE

NUMBER AND STREET CITY ZIP

STUDENT’S ADDRESS: NAME OF FATHER OR GUARDIAN WORK PHONE NAME OF MOTHER OR GUARDIAN WORK PHONE

FAMILY DOCTOR OFFICE PHONE STUDENT’S HOME PHONE

MEDICAL HISTORY GENERAL QUESTIONS YES NO YOUR FAMILY’S HEART HEALTH QUESTIONS YES NO MEDICAL QUESTIONS YES NO

Has a Doctor ever denied or restricted your participation in Sports for any reason?

Does anyone in your family have arrhythmogenic right ventricular cardiomyopathy, long QT syndrome?

Do you have any concerns that you would like to discuss with a doctor?

Do you have any ongoing medical conditions? If so, please Identify by Circling: Asthma Anemia Diabetes

Infections Other:

Has any family member or relative died of heart Problems or had an unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident or sudden infant death syndrome) ?

Were you born without or are you missing an organ? Identify by circling: A kidney An eye Your spleen A testicle (males) Any other organ?

Have you ever spent the night in the hospital? Does anyone in your family have catecholaminergic polymorphic ventricular tachycardia, short QT syndrome?

Have you ever had an eating disorder?

Have you ever had surgery? Do you worry about your weight?

HEART HEALTH QUESTIONS ABOUT YOU YES NO BONE AND JOINT QUESTIONS YES NO Have you ever had a head injury or concussion?

Have you ever passed out or nearly passed out DURING or after exercise?

Have you ever had an injury to a bone, muscle, ligament or tendon that caused you to miss a practice or a game?

Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems?

Have you ever had discomfort, pain, tightness or pressure in your chest during exercise?

Have you ever had any broken or fractured bones or dislocated joints?

Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling?

Do you get lightheaded or feel more short of breath than expected during exercise?

Have you ever had an injury that required x-rays, MRI, CT scan, injections, therapy, a brace or cast or crutches?

Have you ever been unable to move your arms or legs after being hit or falling?

Do you get more tired or short of breath more quickly than your friends during exercise?

Have you ever been told that you have neck instability or atlantoaxial instability (Down syndrome or dwarfism)?

Are you trying to or has anyone recommended that you gain or lose weight?

Has a doctor ever ordered a test for your heart?

For example: ECG/EKG, echocardiogram Have you ever had an x-ray for neck instability or

atlantoaxial instability (Down syndrome or dwarfism)? Are you on a special diet or do you avoid certain

types of foods?

Have you ever had an unexplained seizure or do you have a history of seizure disorder?

Do you regularly use a brace, orthotics, or other assistive device?

Do you wear protective eyewear, such as goggles, or a face shield?

Does your heart ever race or skip beats (irregular beat) during exercise?

Do any of your joints become painful, swollen, feel warm or look red?

Do you or someone in your family have sickle cell trait or disease?

Has a doctor ever told you that you have high blood pressure?

Do you have any history of juvenile arthritis or connective tissue disease?

Have you had any problems with your eyes or vision or had any eye injuries?

Has a doctor ever told you that you have high cholesterol? Have you ever had a stress fracture? Do you wear glasses or contact lenses?

Has a doctor ever told you that you have Kawasaki disease? Have you a bone, muscle, or joint injury bothering you? Have you ever had herpes or MRSA skin infection?

Has a doctor ever told you that you have other heart problems?

IMMUNIZATION HISTORY YES NO Have you had infectious mononucleosis (mono) within the last month?

Has a doctor ever told you that you have a heart infection? Are you missing any recommended vaccines (Tdap, Flu,

MCV4, HPV, Varicella, MMR) Do you have any rashes, pressure sores, or other skin

problems?

Has a doctor ever told you that you have a heart murmur? MEDICAL QUESTIONS YES NO Do You Have Any Allergies?

YOUR FAMILY’S HEART HEALTH QUESTIONS YES NO Have you ever become ill while exercising in the heat? FEMALES ONLY YES NO

Does anyone in your family have a heart problem, Pacemaker, or implanted defibrillator?

Do you cough, wheeze, or have difficulty breathing during or after exercise?

Have you ever had a menstrual period? Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, Brugada syndrome?

Do you have headaches or get frequent muscle cramps When exercising?

How old were you when you had your first menstrual period?

Anyone in your family had unexplained fainting? Do you have pain, a painful bulge or hernia in the groin? How many periods have you had in the last

twelve (12) months?

Anyone in your family had unexplained seizures? Is there any one in your family who has asthma?

Anyone in your family had unexplained near drowning? Have you ever used an inhaler or taken asthma medicine? 

 Our Son/Daughter will comply with the specific insurance regulations of the school district and the Medical History questions are as complete and correct as possible.

Family Insurance Co: Contract #:

Signatures of Student: & Parent/Guardian or 18 Year Old:

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐   < DETACH HERE IF NEEDED TO ACCOMPANY STUDENT ATHLETE  >    ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐  

 Student’s Name:   Grade:

IN EMERGENCY 1) Phone #: Cell #: CONTACT or 2) Phone #: Cell #:

Family Doctor: Phone: Allergies: Drug

Reactions: Current Medications:

EMERGENCY INFORMATION – To Be Completed by Parent or Guardian or 18 Year Old

INSURANCE STATEMENT AND CERTIFICATION

MICHIGAN HIGH SCHOOL ATHLETIC ASSOCIATION, INC.

PHYSICAL EXAM & CLEARANCE & CONSENT FORMS • To be completed by parent or guardian or 18-year-old.

• Must be signed in two places on this page by parent or guardian or 18-year-old.

A CURRENT-YEAR PHYSICAL IS ONE GIVEN ON OR AFTER APRIL 15 OF THE PREVIOUS SCHOOL YEAR

           

MUSCULOSKELETAL

PLEASE PRINT Last  First  Middle 

STUDENT’S COMPLETE LEGAL NAME: 

STUDENT’S  Month    Day    YearDATE OF BIRTH:    │ │

PLACE  City  State OF BIRTH: 

CIRCLE GRADE:  7  8  9  10  11  12  SCHOOL: 

PHYSICAL EXAMINATION & MEDICAL CLEARANCE To be completed by the examining MD, DO, PA or NP & Returned Directly to the patient. Categories may be added or deleted. Check Appropriate Column

EXAMINATION: (Circle Correct Response As Necessary) Height: Weight: Male/Female BP: / Pulse: Vision: R 20/ L 20/ Corrected: Yes No

MEDICAL NORMAL ABNORMAL FINDINGS NORMAL ABNORMAL FINDINGS

Appearance: Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly, arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency)

NeckBack

Eyes/Ears/Nose/Throat: Pupils Equal Hearing Shoulder/Arm

Lymph Nodes Elbow/Forearm

Heart: Murmurs (auscultation standing, supine, +/- Valsalva) Location of point of maximal impulse (PMI) Wrist/Hand/Fingers

Pulses: Simultaneous femoral and radial pulses Hip/Thigh

Lungs: Knee

Abdomen Leg/Ankle

Genitourinary (Males Only) Foot/Toes

Skin: HSV, lesions suggestive of MRSA, tinea corporis Functional: Duck Walk

Neurologic: RECOMMENDATIONS:

I certify that I have examined the above student and recommend him/her as being able to compete in supervised athletic activities NOT crossed out below

BASEBALL - BASKETBALL - BOWLING - COMPETITIVE CHEER - CROSS COUNTRY - FOOTBALL - GOLF - GYMNASTICS ICE HOCKEY - LACROSSE - SKIING - SOCCER - SOFTBALL - SWIMMING - TENNIS - TRACK & FIELD - VOLLEYBALL - WRESTLING

A CURRENT-YEAR PHYSICAL IS ONE GIVEN ON OR AFTER APRIL 15 OF THE PREVIOUS SCHOOL YEAR SIGNATURE OF CIRCLE ONE

EXAMINER: _ MD DO PA NP PRINTED NAME OF EXAMINER: _ DATE:

STUDENT PARTICIPATION & PARENT OR GUARDIAN OR 18 YEAR OLD CONSENT This application to participate in athletics is voluntary on my part and the information submitted is truthful to the best of my knowledge. I have never received money or negotiable certificate for merchandise in any amount, nor any emblematic award or merchandise worth more than twenty-five dollars ($25.00) for participating in athletic events, nor have I ever competed under an assumed name. After I have represented my school in any sport, I will not compete in any outside athletic contest in this sport until after my school season has been completed. I understand that I am expected to adhere firmly to all established athletic policies of my school district and the Michigan High School Athletic Association, such as those previously mentioned above as examples but which do not present all the policies to which I am subject.

I hereby give my consent for the above student to engage in interscholastic athletics and for the disclosure to the MHSAA of information otherwise protected by FERPA and HIPAA for the purpose of determining eligibility for interscholastic athletics; and I understand the possibility that serious injury may result from participating in athletic activities. He/She has my permission to accompany the team as a member on its out-of-town trips.

I further understand that my son or daughter will be expected to adhere firmly to all established athletic policies of the school district and the Michigan High School Athletic Association.

Signature of STUDENT: Date:

Signature of PARENT: Date:

or GUARDIAN or 18 YEAR-OLD

------------------------------- < DETACH HERE IF NEEDED TO ACCOMPANY STUDENT ATHLETE > ---------------------------------------------

MEDICAL TREATMENT CONSENT – To Be Completed By Parent or Guardian or 18-Year-Old

I, , an 18 year-old, or the parent or guardian of _ recognize that as a result of athletic participation, medical treatment on an emergency basis may be necessary, and further recognize that school personnel may be unable to contact me for my consent for emergency medical care. I do hereby consent in advance to such emergency care, including hospital care, as may be deemed necessary under the then-existing circumstances and to assume the expenses of such care.

 

SIGNATURE OF PARENT OR GUARDIAN OR 18 YEAR-OLD DATE

OAKLAND MACOMB YOUTH FOOTBALL ASSOCIATION

SHELBY LIONS 2015 ATHLETIC CONSENT FORM

_________________________________________________________________________________________ I, ____________________________________, while a participant with the _________________________________ will:

Student Athlete

1. Keep up with my school work and grades. 2. Attend all practices, team meetings and competitions. 3. Follow all __________________________________ & OMYFA policies including discipline, attendance, etc. 4. Follow all team rules and policies. 5. Contact the coach personally or in writing if I am unable to attend a practice, team meeting or competition. 6. Replace any equipment or uniform issued to me, either by payment or the equivalent of the lost article. 7. Report any personal injury or teammate's injury to the coach and athletic trainer immediately. 8. Treat opponents with respect. 9. Respect the judgment of contest officials, abide by the rules of the contest and display no behavior that would draw

attention away from the contest. 10. Cooperate with contest officials, coaches, and fellow participants to conduct a fair contest. 11. Accept seriously the responsibility and privilege of representing the _______________________________, the

OMYFA and our community, display positive actions at all times. 12. Be no party to the use of profanity, obscene language, or improper actions. 13. Live up to the high standard of sportsmanship established by the coach, and the OMYFA.

Parent/Guardian

1. Respect the decisions made by the coaching staff. 2. Respect the decisions made by the contest officials. 3. Be an exemplary role model by positively supporting teams in every manner possible, including cheers vs. jeers. 4. Respect fans and athletic participants. 5. Realize that a ticket is a privilege to observe a contest and support youth football and cheerleading. 6. Follow all _______________________________ & OMYFA policies including discipline, attendance, etc.

Coaches

1. Always stress the importance of academics to our student-athletes. 2. Always set a good example for participants and fans to follow. 3. Instruct student-athletes in proper sportsmanship responsibilities. 4. Respect the judgment of contest officials, abide by the rules of the event and display no behavior that would draw

attention away from the contest. 5. Treat opposing coaches, participants and fans with respect. 6. Respect the integrity and personality of the individual student athlete. 7. Develop and enforce policies for sportsmanship standards. 8. Abide by and teach the rules of the game in letter and in spirit. 9. Be no party to the use of profanity, obscene language or improper actions. 10. Be sure background check is turned into the __________________________________ and the OMYFA.

X_____________________________________________ _____________ _______________________

PARTICIPANT SIGNATURE AGE DATE SIGNED X_____________________________________________ _______________________

PARENT/GUARDIAN SIGNATURE DATE SIGNED X_____________________________________________ _______________________

HEAD COACH SIGNATURE DATE SIGNED

OAKLAND MACOMB YOUTH FOOTBALL ASSOCIATION

SHELBY LIONS 2015 MEDICAL TREATMENT FORM

______________________________________________________________________________________

PARENTAL CONSENT FOR MEDICAL TREATMENT OF MINOR IF THE APPLICANT IS UNDER 18 YEARS OF AGE, THE PARENTS OR GUARDIANS MUST EXECUTE IN PLACE OF THE MINOR. I HEREBY AUTHORIZE ANY DULY AUTHORIZED DOCTOR, ATHLETIC TRAINER, EMERGENCY MEDICAL TECHNICIAN, PARAMEDIC, NURSE, HOSPITAL OR OTHER MEDICAL FACILITY TO TREAT SAID MINOR FOR THE PURPOSE OF ATTEMPTING TO TREAT OR RELIEVE ANY INJURIES RECEIVED BY OR ILLNESS OF SAID MINOR WHILE HE/SHE IS A PARTICIPANT OR OBSERVER AT THE EVENT NAMED BELOW. I AUTHORIZE ANY LICENSED PHYSICIAN TO PERFORM ANY PROCEDURE WHICH HE/SHE DEEMS ADVISABLE IN ATTEMPTING TO TREAT OR RELIEVE ANY INJURIES TO OR ILLNESS OF SAID MINOR THAT HE/SHE MAY ENCOUNTER DURING ANY NECESSARY OPERATION. I CONSENT TO THE ADMINISTRATION OF ANESTHESIA TO SAID MINOR AS DEEMED ADVISABLE BY ANY LICENSED PHYSICIAN.

THE UNDERSIGNED PARENT OR NATURAL GUARDIAN OR LEGAL GUARDIAN OF SAID MINOR DOES HEREBY REPRESENT THAT HE/SHE IS, IN FACT, IN SUCH CAPACITY AND TO THE EXTENT PERMITTED BY LAW AGREES ON HIS BEHALF AND THAT OF THE MINOR TO SAVE AND HOLD HARMLESS AND INDEMNIFY OAKLAND-MACOMB YOUTH FOOTBALL ASSOCIATION, ITS ELECTED AND APPOINTED OFFICIALS, EMPLOYEES AND VOLUNTEERS, EVENT HOLDERS AND SPONSORS, DOCTORS, EMERGENCY MEDICAL TECHNICIANS, ATHLETIC TRAINER, PARAMEDICS, NURSES, HOSPITALS OR OTHER MEDICAL FACILITIES FROM ALL LIABILITY, LOSS, COST, CLAIM OR DAMAGE WHATSOEVER THAT MAY BE IMPOSED UPON OR INCURRED BY SAID PARTIES BECAUSE OF THE PARTICIPATION OF THE MINOR IN THE EVENT SHOWN, AND DOES RELEASE SAID PARTIES ON BEHALF OF BOTH THE PARENTS OR LEGAL GUARDIAN.

STUDENT PARTICIPATION THIS APPLICATION TO PARTICIPATE IN ATHLETICS IS VOLUNTARY ON MY PART AND THE INFORMATION SUBMITTED IS TRUTHFUL TO THE BEST OF MY KNOWLEDGE. I HAVE NEVER RECEIVED MONEY OR NEGOTIABLE CERTIFICATES FOR MERCHANDISE IN ANY AMOUNT, NOR ANY EMBELMATIC AWARD OR MERCHANDISE WORTH MORE THAN TWENTY-FIVE DOLLARS ($25.00) FOR PARTICIPATING IN ATHLETIC EVENTS, NOR HAVE I EVER COMPETED UNDER AN ASSUMED NAME. AFTER I HAVE REPRESENTED MY TEAM IN ANY SPORT, I WILL NOT COPETE IN ANY OUTSIDE ATHLETIC CONTEST IN THIS SPORT UNTIL AFTER THE OAKLAND-MACOMB YOUTH FOOTBALL ASSOCIATION SEASON HAS BEEN COMPLETED. I UNDERSTAND THAT I AM EXPECTED TO ADHERE FIRMLY TO ALL ESTABLISHED ATHLETIC POLICIES OF MY TEAM AND THE OAKLAND-MACOMB YOUTH FOOTBALL ASSOCIATION, SUCH AS THOSE PREVIOUSLY MENTIONED ABOVE AS EXAMPLES BUT WHICH DO NOT PRESENT ALL THE POLICIES TO WHICH I AM SUBJECT. I GIVE MY PERMISSION FOR MY CHILD TO RECEIVE A PHYSICAL FROM THE DOCTOR THE LEAGUE HAS PROVIDED OR I MAY GET ONE FROM MY OWN PHYSICIAN. I HEREBY GIVE MY CONSENT FOR MY SON/DAUGHTER TO ENGAGE IN INTERSCHOLASTIC ATHLETICS AND UNDERSTAND THE POSSIBILITY THAT SERIOUS INJURY MAY RESULT FROM PARTICIPATING IN ATHLETIC ACTIVITIES. I FURTHER UNDERSTAND THAT MY SON/DAUGHTER WILL BE EXPECTED TO ADHERE FIRMLY TO ALL ESTABLISHED ATHLETIC POLICIES OF THE OAKLAND-MACOMB YOUTH FOOTBALL ASSOCIATION.

BY SIGNING BELOW I AGREE TO ALL OF THE ABOVE EVENT: OAKLAND-MACOMB YOUTH FOOTBALL ASSOCIATION ______________________________________________ _____________ PARTICIPANTS NAME AGE X_____________________________________________ _______________________ PARENT/GUARDIAN SIGNATURE DATE SIGNED

OMYFA (AYF) WAIVER

Shelby Lions Football Club Minor/Participant Waiver and Release RELEASE OF LIABILITY FOR MINOR PARTICIPANTS

READ BEFORE SIGNING

In consideration of __________________________, my child, being allowed to participate in any and all functions, Name of Club Participant

activities, games, practices, and/or events of the Shelby Lions Football Club Teams, including its Cheerleader Squads, the undersigned

acknowledges, consents to, and agrees to the following:

1. The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; and,

2. Myself, my spouse (if applicable), and child knowingly and freely assume all risks associated with participating in the Shelby

Lions Football Club activities, both known and unknown even if arising from the negligence and/or malfeasance of the Releasees or others, and assume full responsibility for my child’s participation; and,

3. I willingly agree to comply with the Rules, Regulations, and all other protocol and/or guidance of the Shelby Lions Football Club,

which I understand are mandatory conditions that must be complied with by all parents and/or participants in order to engage in Club activities. If I observe any unusual and/or significant concern in my child’s readiness and/or ability for participation in the program itself, I agree to remove my child from participating in Club activities and bring such attention to the head coach and/or highest ranking official involved with my son’s specific team and/or squad immediately; and

4. On behalf of myself, my spouse (if applicable), my child, and on behalf of our heirs, assigns, personal representatives, and/or

other beneficiaries, hereby release and hold harmless the Shelby Lions Football Club, its directors, officers, officials, agents, employees, coaches, assistant coaches, trainers, General Managers, other participants, sponsoring agencies, sponsors, advertisers, and if available and/or applicable, all owners and/or lessors of premises used to conduct any Shelby Lions Football Club events or activities (herein designated as “Releasees”), with respect to any and all injury, disability, death, and/or other loss or damage to person or property related to my child’s involvement or participation in the Club programs, whether arising from the negligence and/or malfeasance of the Releasees or otherwise to the fullest extent permitted under Michigan law.

5. I, my spouse (if applicable), my child, and on behalf of our heirs, assigns, personal representatives, and/or other beneficiaries,

hereby indemnify and hold harmless the Shelby Lions Football Club and all of the above-named Releasees from any and all liability whatsoever incident related to my child’s involvement and/or participation in any programs, activities, games, or other events of the Shelby Lions Football Club, even if arising from the Releasees’ negligence to the fullest extent permitted under governing Michigan law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND BY SIGNING THIS DOCUMENT ACKNOWLEDGE THAT I FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP CERTAIN RIGHTS BY EXECUTING THIS DOCUMENT, AND HAVE SIGNED THIS DOCUMENT FREELY AND VOLUNTARILY, WITHOUT ANY UNDUE COERCION, DURESS, OR IN ANY OTHER WAY CONTRARY TO MY FREE WILL AND VOLUNTARY CHOICE.

(PARENT/GUARDIAN SIGNATURE) (PRINT NAME) Date Signed:

UNDERSTANDING OF RISK I understand the seriousness of the risks involved in participating in the Shelby Lions Football Club and its related programs and acknowledge my personal responsibilities for adhering to all Club Rules and Regulations, accepting them as a participant of the Shelby Lions Football Club and its related teams and/or squads.

(PARTICIPANT SIGNATURE) (PRINT NAME)

NAME: ________________________ SQUAD: ______________________

2015

EMERGENCY/MEDICAL INFORMATION

PLEASE INDICATE IF YOUR CHILD HAS ANY CONDITIONS, IS TAKING ANY MEDICATION AND/OR IS ALLERGIC TO MEDICATION OR ANYTHING (EXAMPLE: ASTHMA, ALLERGIES, ETC.)

______ FOOTBALL _______ CHEERLEADING

INSURANCE COMPANY

__________________________________________

CONTRACT # _________________________________________

GROUP #

____________________________________________

REFUND POLICY

THERE WILL BE NO REFUNDS OF ANY KIND ISSUED AFTER

MAY 31, 2015

IF YOU ARE UNABLE TO PARTICIPATE IN THE SHELBY LIONS FOOTBALL

CLUB FOR ANY REASON AFTER MAY 31, 2015 YOUR REGISTRATION FEE

WILL BE CONSIDERED A DONATION TO THE SHELBY LIONS FOOTBALL

CLUB.

**************************************************************

By signing below, I acknowledge that I have received, read, and agree to abide by the Shelby

Lions Football Club Refund Policy.

___________________________________ _____________________________ Signature of Parent / Guardian Date

___________________________________ _____________________________ Player’s Name Team / Squad

We are an all Volunteer Club!

Welcome to the upcoming 2015 season of the Shelby Lions! Our organization is only as good as its volunteers, and as a member of the Shelby Lions Football Club we are all volunteers. As a member of the Shelby Lions Football Club, you agree to help out and volunteer at our home games, or fulfill other volunteer commitments for the 2015 season. We have a proud tradition with very helpful families, and without you we couldn't do what we do for our kids!

2015 Volunteer Information!

Each family is required to fulfill at least (TBD) number of commitments per family, not per child (Usually six (6) or seven (7) spots) dependent on how many families we have register.

Any person or person(s) 18 years of age or older can volunteer for a family to meet the commitment requirement. This can be a parent, guardian, step parent, older sibling, grandparent, aunt, uncle, family friend, etc. You are expected to find a replacement to take your position if you are unable to attend the commitment you signed up for.

You will have the opportunity to select your volunteer dates and times at Parent Night or Equipment Distribution. Please be sure to bring your calendars to these functions so you may plan accordingly.

Reminder!

As in the past, we will be requiring a volunteer deposit ($100), which will be payable via check at Equipment Distribution. Your check will be held and returned to you at Equipment Return in November if your volunteer commitments for the season are fulfilled.

However, if you do not fulfill TBD volunteer times you are asked to commit

to, your check will be cashed and considered a donation to the Shelby Lions Football Club. We hope you understand that we simply cannot continue to run a successful program without your commitment and prefer that you become involved with your child(ren) and volunteer your time. In the event that your $100 check is cashed, your child will no longer be eligible for return registration, but will need to wait until open registration where open spots are subject to availability.

You are supporting Shelby Lions Football & Cheerleading when

you buy a 2-year subscription to ESPN The Magazine for $40. Shelby Lions will keep $30 from every order!

*** You receive over 80% off the newsstand price and 2 years of ESPN Insider (a $79.90 value) with each order. ***

Institution Name: Shelby Lions Team ID: 27652 Team Contact: Ed Gehle Sport: Football & Cheerleading

P. O. Box 182215 Utica, MI 48318

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By supplying your e-mail address we will contact you regarding your ESPN The Magazine subscription. Subscriptions will start 8-10 weeks upon receipt of orders. ……………………………………………………………………………………………………………………………………………………………………………………

To activate your subscription or renewal, please provide the following information: □ I’d like to send this magazine as a gift to:

_________________________________________________________ _______________________________________________________ NAME (PLEASE PRINT) RECIPIENT NAME _________________________________________________________ _______________________________________________________ ADDRESS ADDRESS _________________________________________________________ _______________________________________________________ CITY/STATE/ZIP CITY/STATE/ZIP _________________________________________________________

I acknowledge I have purchased ESPN The Magazine through a EMAIL ADDRESS participant in ESPN Coaches Fundraising program._____________

Initial here By supplying your e-mail address we will contact you regarding your ESPN The Magazine subscription. Subscriptions will start 8-10 weeks upon receipt of orders.