East Tulsa Trojans Sign Up Sheet
Child's name  _______________________________________________
Age on Sept 1st this year____    Grade on Sept 1st this year____   
Gender ______       DOB____-____-_________
Home Phone #_____-_____-______  Cell Phone #_____-_____-______
School name______________________ City___________________St___

Parents name_________________________________
Child's Residential Address____________________________________
City____________________________St________ Zip code_________
Email___________________________________
PARENTAL PARTICIPATION CONSENT & AUTHORIZATION FOR EMERGENCY TREATMENT/RELEASE OF LIABILITY CONTRACT FORM-PLEASE READ CAREFULLY
PARTICIPATION AUTHORIZATION AND RELEASE OF LIABILITY:
I,___________________________________(parent/guardian) for himself/herself and for his/her spouse and for his/her child (participant) and other children hereby represent and agrees to the following:
My child,___________________________________has my permission to participate in all ETYSA sponsored or endorsed activities. The (ETYSA) and it's Board Members and Directors, Officers, Coaches, Coaching staffs, agents and licensees are hereby released from any and all liability or responsibility for any injury that may occur to my child, to me, to my spouse and any of the other children resulting directly or in directly from my child's participation in (ETYSA) activities including, but not necessarily limited to, league tournaments, practice games, practices, transportation to and from games and tournaments or otherwise and the use of practice facilities, game facilities, concession facilities, or any other facilities_______(please initial)
INSURANCE RELEASE: PLEASE CHECK THE APPROPRIATE BOX INDICATING INSURANCE COVERAGE.
____1. This is to certify that my child is covered by the following medical/accident insurance________________________________
____2. This is to certify I DO NOT have medical/accident insurance covering my child. However, he/she has my permission to participate in all (ETYSA) activities.
AUTHORIZATION FOR EMERGENCY TREATMENT:
In the event of a medical emergency, I hereby authorize my child to be transported to nearest emergency medical center. I also authorize officials at (ETYSA) to secure the use of an ambulance for transporting my child to the hospital and/or to administer first aid treatment as necessary,
RULES AND REGULATIONS CONTRACT:
I_________________________parent/guardian), have read the (ETYSA) Member rules and regulations, of which I have a copy, as stated by the Board of Directors of the (ETYSA). I hereby agree to abide by said rules and regulations. I have also read and fully understand the penalties prescribed by (ETYSA) for violation or noncompliance of said rules and regulations and by my signature do agree to these terms and conditions.  I also give (ETYSA), American youth football, east Tulsa Trojans, or any other associate with them the permission to use my child's name and/or picture in their website, publications, media releases or in any other forum they see fit.
I am aware and agree that i am responsible to turn my child's helmet and shoulder pads back into the appropriate club personnel.  If this is not done after my child's last game, I will be responsible to pay ETYSA $90 for the helmet and $60 for the shoulder pads.  This money would become due immediately.

Is the child currently placed on a team________
If so what team/coach____________________________ 

Signature___________________________________________ Date___-___-____
DON'T WRITE BELOW--CLUB USE ONLY
Grade/level____Fee$____CK#____ Cash______Pmt$______ Balance due $______