2003 Registration Application
Team: Varsity______ JV______ PW______
SPW______ Clinic______ Flag______
Fees: $150 for one
player (contact teams) $65
each player (flag team)
$100 each
additional family member. No
Refund after Equipment Pick-up in June
Late
Registration (after 7/1/2003): $25 Returned Check Fee: $15 per Check
Player Name:
________________________Phone:
_______________ E-mail address:__________________
Address:
_________________________________________ Town: ___________________ZIP: __________
Date of Birth:
___________________
Sex: Male / Female Weight (lbs.): ________________
School (Sept. 2003):
______________________________________ Grade (Sept. 2003):
___________
Parent's/Guardian's Last Name (if
different):__________________________________________
Father's Name:
_________________________________
Occupation: ______________________________
Mother's Name:
________________________________
Occupation:_______________________________
Parent/Guardian Please Read and Complete
The Long Valley Raiders Football Association is
a volunteer organization that receives no financial assistance from the town. In
order to field the teams, pay for approximately $300 worth of equipment per
player and other costs such as lighting, field use fees, practice equipment,
etc., the Raiders rely on the participation of all parents/guardians to give
your children the chance to participate in Football. We ask all parents/guardians to help make this year
successful. We ask your participation
on at least two occasions for any organizational activity. Please
sign up for at least one activity that interests you. If
you have no preference, an activity will be assigned to you.
Assistant Coach _____ Concession Stand _____ Equipment
Maintenance _____
Publicity _____ Videotape
Games _____ Team
Pictures _____
Team Representative _____ Yearbook _____ Apparel
_____
Varsity Banquet _____ Recognition Night _____ Referee
(Clinic/SPW) _____
Game Announcer _____ Scoreboard Operation _____ Field Maintenance
_____
Check
HERE if you are interested in hearing more about
Raiders social events!!
WILL YOUR CHILD BE COVERED BY YOUR OWN MEDICAL
INSURANCE? YES ____
NO_____
Note: Primary Medical Coverage is provided by
individual. Town Insurance is
Secondary. Raiders Insurance is
Tertiary.
I
hereby give my approval for the above candidate to participate in any and all
Long Valley Raiders Football Association and Morris County Midget Football
League activities during the upcoming season until completion. I also agree to furnish a Birth Certificate
and Medical Permission Form for the above candidate. Included in the registration fee is automatic membership in the
Long Valley Raiders Football Association.
I agree to attend regular monthly meetings when possible, and
acknowledge that I have been afforded the opportunity to read the by-laws of
the Long Valley Raiders Football Association.
Signature
of Parent/Guardian ________________________________________ Date ________________
Registration Received by: ญญญ_____________________________________________ Date: ____________________________
Amount Received: $_____________ Cash _________ Check No. ___________ Multiple Children ___________
Notes: