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NFL 5 on 5 Flag Football

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2021 NFL Flag Football Registration

Hickman Youth Sports

Hickman Parks & Recreation Department - P.O. Box 127, Hickman, NE 68372

www.hickman.ne.gov

 

Participant Name:  Date of Birth:  Age: 

 

Sex:  M  F  Current Grade in School  Special Request (Coach):   

 

Parent Name:  Phone Number: Cell () 

 

Address: City:  State:  Zip: 

 

Email Address:

 

   I am Interested in Coaching - Name:  Email: 

 

$65 Coed NFL Flag Football grades K-5th years for school year 2021-2022

(Includes NFL Reversible Team Jersey)

  T-Shirt Size: (check one) Youth Sizes:  S (6/8) M (10/12)  L (14/16) Adult Sizes: S M L XL

Please Select an Age Division:

Kindergarten to 1st grade Division2nd  to 3rd Grade Division4th to 5th Grade Division

  Check here if you DO NOT give permission for your minor child/ward(s) picture(s) to be on the City of Hickman Facebook, Website and/or Newsletter

REGISTRATION DEADLINE: July 31st, 2021

Late Fee of $15.00 Will Apply to Registrations Received After July 31st

NO REGISTRATIONS WILL BE ACCEPTED AFTER Aug 14th, 2021 at 5:00pm

Financial Assistance Program May Be Available

  I have read the Parent/Athlete Concussion Information Sheet

WAIVER AND RELEASE OF LIABILITY

Please read this form carefully and be aware that in participating you will be waiving and releasing all claims for injuries that you or your minor child/ward might sustain arising out of this participation.

As a participant or parent/guardian of a participant, I recognize and acknowledge that there are certain risks of physical injury and agree to assume the full risk of any injuries, including death, damages or loss which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with this program.

I agree to waive and relinquish all claims I or my minor child/ward may have against the City of Hickman and its officials, officers, agents, servants and employees as a result of participating. I do hereby fully release and discharge the City of Hickman and its officials, officers, agents, servants, employees and volunteers from any and all claims from injuries, including death, damage or loss which I or my minor child/ward may have or which may incur or may accrue to me or my minor child/ward on account of my participation.

I further agree to indemnify and hold harmless and defend the City of Hickman and its officials, officers, agents, servants, employees and volunteers from any and all claims resulting from injuries, including death, damages and losses sustained by me or my minor child/ward and or arising out of connected with, or in any way associated with the activities of my participation.

In accordance with Nebraska Statute 71-9105 (2011), parents and coaches must review the provided items that address the following:

  1. The Signs and Symptoms of a Concussion;
  2. The Risks Posed by Sustaining a Concussion; and,
  3. The Actions an athlete should take in response to sustaining a concussion, including the notification of his or her coaches. (More information is available at www.cdc.gov/concussion/HeadsUp/youth.html)

 

By signing this form I acknowledge that I have read and fully understand the above warning of Risk and Waiver and Release of All Claims and have received information in accordance with Nebraska Statute 71-9105 regarding concussions.

 

Parent/Guardian Signature (Required)        Date 

 


 

 

 

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