Pine Bush Youth Football & Cheerleading
2009 Online Registration form
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Orange County Youth Football League (OCYFL)

Pine Bush Youth Football League Inc. (PBYFL)

P.O. Box 630 Pine Bush, NY 12566

Hotline: 845-695-1932 – Web Site: www.pbyfl.org

2010 Registration Form      

Family Name
Todays Month
Date
Year
Football PlayerCheerleader
Player name
Home Phone
Cell Phone
Address
Town
State
Zip Code
E-Mail Address
PLAYERS DATE OF BIRTH
Grade on 09/2010
Age on 11/30/10
School Name:
Parent / Guardian Name
Emergency Contact
Emergency Contact Phone Number
Allergies
Medications
Conditions

I-We the parents/guardians of the above named candidate for a position on a youth football  or cheerleading team, hereby give my/our approval to participate in any and all youth football or cheerleading activities. I/We assume all risks and hazards incidental to such participation including to and from the activities: and I/We hereby waive, release, absolve, indemnify and agree to hold harmless the OCYFL, PBYFL, the organizers, sponsors, managers, coaches, referees, league, board members, safety officer, announcer, timekeepers, supervisors, participants, and persons transporting my/our child to and from activities from any claim arising out of injury to my/our child whether the result of negligence or for any cause, except to the extent, and in the amount covered, by accident or liability insurance.

BIRTH CERTIFICATE REQUIRED AND KEPT ON FILE WITH REGISTRATION.  A SIGNED PARENT CODE OF CONDUCT AND A MEDICAL FORM SIGNED AND DATED BY PHYSICIAN FOR THE CURRENT YEAR ARE ALSO REQUIRED TO BE ELIGIBLE TO PARTICIPATE IN THE OCYFL / PBYFL.

Fee: 1st Football $140 – 2nd Football $110 – 1st Cheer $105 - 2nd Cheer $100 – Highest Amount will be used 1st

Work Bond - $75 Per Family – Raffle - $50 per child  - 

A $50 per child filling fee will not be refundable. There will be no refunds of any funds given after June 1st of each year, unless a documented medical reason and or Board approval is given.  There is a $25 late sign up fee charged for any registrations after May 1st of each year.