2019 League Registration
General Information:
Mailing Address
Street 1: *
Street 2:
City: *
State: * Ohio
ZIP Code: *
Primary Email Address
Email Address: *
Primary Phone
Phone Number: *
Contact Information:
Full Name:
Home Phone:
Cell Phone:
Work Phone:
Email Address:
Full Name:
Home Phone:
Cell Phone:
Work Phone:
Email Address:
I would be willing to assist in the following positions:
Emergency Information:
Emergency Contact
Full Name: *
Home Phone:
Other Phone:
Insurance Information
Carrier Name: *
Policy Number: *
Doctor Information
DR/Practice Name: *
Phone Number: *
Dentist Information
DDS/Practice Name: *
Phone Number: *
Participant Information:
Saved Participants:
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Waivers and Acknowledgements:
NOTICE!  Prior to submitting this form, you must read the following waivers and acknowledgements. Check of the box to the left of each section before continuing. Doing so verifies you have read and understand the statements below.
Waiver of Liability
By checking this box and submitting this registration form, the parent, guardian, or custodian (responsible person) of children participating in the Jackson Youth Football Association activities do hereby release the association, its officers, directors members, coaches, and players from any and all liability for any injuries to parents, family members, or participants as a result of participation in association activities, including but not limited to games and practices. The responsible person also waives any liability resulting from association action in a situation involving a participant requiring emergency medical attention, as outlined below. The responsible person also understands that football is an inherently dangerous activity, with a great deal of physical contact between participants of different size and skill level. The responsible person also understands that association coaches are volunteers and do not guarantee any special level of expertise. The responsible person affirms that he or she has the authority to sign such a waiver of liability for the signer, child(ren), and other responsible person. Signature affirming this waiver of liability is required for association participation.
Acknowledgment of Rules and Regulations
Responsible party acknowledges and agrees to follow and be bound by the league written rules and regulations. These guidelines must be followed by the responsible parent and participating child(ren) in the league. The JYFA strongly suggests your athlete have a complete physical for this season.
Emergency Medical Attention
Should an emergency arise during an association activity and a responsible parent, custodian, or guardian is not present, the association will use reasonable efforts to secure emergency medical attention and to notify the appropriate family member immediately.
Responsible Person
I hereby affirm that all of the information on the registration form is true. I also give my permission to the association to use its best judgment in giving emergency medical attention to my child(ren). I also hereby waive any liability on the part of the association and others as outlined in the WAIVER OF LIABILITY. I also affirm that I have completely read and understand the WAIVER OF LIABILITY and association policies concerning eligibility and EMERGENCY MEDICAL ATTENTION.
Lindsay's Law Information Review
I hereby affirm I have reviewed the details presented to me regarding Lindsay's Law by watching this video, reading and understanding this informational handout, and reviewing and understanding this signature form. A new window/tab will open for each link.
Parental Code of Conduct
Jackson Youth Football Association has implemented the following Parental Code of Conduct. I recognize and accept my responsibility as a representative of the Jackson Youth Football Association and my child’s football team and pledge to follow this Parental Code of Conduct:
  • I will remember that children participate to have fun and that the game is for players, not adults. I will do my best to make football fun for my child.
  • I will inform the coach of any physical disability or ailment that may affect the safety of my child or the safety of others.
  • I will learn the rules of the game and the policies of the league.
  • I will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy, and by demonstrating positive support for all players, coaches, officials and spectators at every game, practice, or other event.
  • I will not engage in any kind of unsportsmanlike conduct with any official, coach, player, or parent such as booing and taunting, refusing to shake hands, using profane language or gestures, or using physical violence.
  • I will not attempt coach my child or any other player from the stands. I will limit my comments to positive reinforcement and encouragement to my child and his/her teammates.
  • I will treat players, coaches, officials, and spectators with respect. I will respect their authority during games and will use 24 hours after each game as a “cooling off” period before questioning, discussing, or confronting coaches, umpires or other officials. I will never engage in any of these confronting behaviors in front of a player.
  • I will take any and all conflicts through the proper channels. If a resolution cannot be reached or I do not feel comfortable handling the matter, I will take it to the Board of the Association.
  • I will always remember that the coaches and Board Officials are volunteers. They are always trying to make decisions that are in the best interest of the league and its players.
  • I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence. I will teach my child to treat other players, coaches, officials, and spectators with respect.
  • I will teach my child that doing one’s best is more important than winning, so that my child will never feel defeated by the outcome of a game or his/her performance. I will never ridicule or yell at my child or other participants for making a mistake or losing a game.
  • I will emphasize skill development for my child, and will recognize the importance of this benefit over winning. I will also de-emphasize games and competition in the lower age groups.
  • I will promote the emotional and physical well-being of the athletes ahead of any personal desire that I may have for my child to win.
  • I will respect the officials and their authority during games and practices. I will never question, discuss, or confront coaches at the field, and will take time to speak with coaches at an agreed upon time and place.
  • I will help keep the field clean by disposing of my trash in the proper receptacles after each game and practice.
  • I will demand a sports environment for my child that is free from drugs, tobacco, and alcohol, and I will refrain from their use at all practices and games.
**By checking the box above, I acknowledge that I am responsible for the behavior for myself, my spouse, my family and my guests. Violations of any of the above pledges will be taken under the advisement by the Board, whose decision on penalty will be final.** Thank you for your participation in and commitment to Jackson Youth Football Association. We are looking forward to another wonderful and successful season of football.