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Fairview Titans Jr. Pro Football Program

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2019 Parental/Guardian Permission and Waiver


1. PERMISSION TO PARTICIPATE: I, the parent/guardian of the above-named participant hereby acknowledge that my child is in good general health and I give my approval for my child to participate in any and all Fairview Titans Jr. Youth Football Program team/squad activities. I understand, hereby give my approval for, and assume any and all risk of my child's use of various playing surfaces and conditions, including, but not limited to, dry and wet natural and artificial grass, hard dirt, and/or mud and I hereby acknowledge and understand that said surfaces may be regular or very irregular.


2. INTENT TO INFORM: I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand that participation in football and cheerleading may result in SERIOUS INJURIES, PARALYSIS, PERMANENT DISABILITY AND/OR DEATH. Furthermore, I fully acknowledge and understand that protective equipment does not prevent all participant injuries, and therefore I do hereby waive, release, absolve, and agree to hold harmless the Fairview Titans Jr. Youth Football Program and any and all organizers, sponsors, supervisors, participants, and persons transporting the above named participant to and from activities, from any claim arising out of any injury to my/our child whether the result of negligence or for any other cause.


3. EMERGENCY MEDICAL AUTHORIZATION: I hereby grant my permission for any and all emergency medical/dental treatment and/or first aid to be administered to my child/participant, including authorizing any medical treatment facility/hospital to administer emergency treatment, for any illness/injury/accident resulting from participation in any and all Fairview Titans Jr. Youth Football Program activities.


4. EQUIPMENT RESPONSIBILITY: I agree to assume full responsibility for any and all equipment/uniforms loaned to the above named participant and I agree to promptly return, upon request, the uniform and other equipment issued to the above named participant in as good condition as when received except for normal wear and tear. If I fail to adhere to this policy, I will be responsible for the full replacement cost of such equipment.


5. INSURANCE DISCLOSURE: I am aware that the Fairview Titans Jr. Youth Football Program organization carries group accident insurance which is considered secondary or excess for medical purposes to any and all valid insurance I possess is considered primary insurance. Furthermore, I agree to notify in writing my head coach and Fairview Titans Director of any medical claim as a result of participation in Fairview Titans Jr. Youth Football Program activities as soon as reasonably possible. I understand that any registration fee paid does not constitute a direct premium for insurance and that a deductible(s) may apply.


6. VOLUNTEER OBLIGATIONS: I acknowledge that I am obligated to sign up and participate as a parent/guardian volunteer for the Fairview Titans Jr. Youth Football Program. I will be required to sign up for one home game to work in the concession stand, gate entrance, or chain/down marker  at the beginning of the season, and failure to do so will put me at risk of losing my eligibility in the Fairview Titans Jr. Youth Football Program the following year.


7. REFUNDS: I understand that payment is made in full at time of registration and that as of August 1, 2015 I will no longer be returned any registration fees that I have paid to the Fairview Titans Jr. Youth Football Program. I understand that jerseys/uniforms orders have been placed and that I will not hold the Fairview Titans Jr. Youth Football Program responsible financially for my decision to leave the Fairview Titans Jr. Youth Football Program.

8. FINANCIAL RESPONSIBILITY: I hereby stipulate that I have been advised by the Fairview Titans of my rights, if any, to a refund in accordance with the local organization policies, and I have also been advised of my volunteer obligations for the entire season and agree to fully comply with those obligations.


9. COMMUNICATION AND PROMOTIONAL CONSENT: As a condition to my child’s participation, I hereby consent to receive communications via email and mail from Fairview Titans Jr. Youth Football Program.  Furthermore, I hereby grant to Fairview Titans Jr. Youth Football Program the absolute right and permission to make, reproduce, broadcast or otherwise use participant’s name and likeness, any photograph, films, videos, recordings, or other depictions or images in whatever form or media in connection with participation in Fairview Titans Jr. Youth Football Program and in any and all advertising and promotion materials, in any manner or media whatsoever for purposes of art, advertising, editorial, trade or promotion or any other purpose whatsoever. To the extent that any benefit accrues or may accrue to Fairview Titans Jr. Youth Football Program, I hereby and forever waive any interest in or claim to such benefits and acknowledge that the Fairview Titans are under no obligation to exercise any rights granted herein.


10. ADULT CODE OF CONDUCT: S1: In order to uphold the goals of the Fairview Titans Jr. Youth Football Program and ensure that all participants have the benefit of a safe and fun learning environment, all parents, guardians and other adults and attendees of Fairview Titans Jr. Youth Football Program events, including but not limited to practices, competitions, and banquets, must behave accordingly in a respectful, courteous and sportsmanlike manner at all times. S2: Any adult who is using alcohol, tobacco or non-prescription drugs and/or appears intoxicated at a Fairview Titans Program event, and/or who is flagrantly rude, attempts to intimidate, verbally abuse, heckles, taunts, ridicules, boos, throws objects and/or uses vulgarity or profane language/gestures with an official, coach, volunteer, staff member, participant or other event attendee, must receive a verbal warning and/or be asked to leave a Fairview Titans Jr. Youth Football Program event. The member organization may also provide a written warning to the individual regarding the misbehavior. The adult’s children may also be removed from the event. Any adult, who commits one of the above stated offenses a second time, will be banned from any and all Fairview Titans Jr. Youth Football Program events for a period of one year from the date of the second offense, and their children may also be removed from the program(s) for that time period. S3: Any adult who physically assaults an official, coach, volunteer, staff member or participant or threatens grave bodily harm may be banned from any and all Fairview Titans Jr. Youth Football Program events for one year from the date of the offense, and their children may also be removed from any and all Fairview Titans Jr. Youth Football Program events for that same period of time. After the ban has expired, if the individual commits another offense of the adult code of conduct, the individual will be permanently banned from any and all Fairview Titans Jr. Youth Football Program events and the individual’s children may also be permanently removed from any and all Fairview Titans Program events.


11. ADHERENCE TO FAIRVIEW TITANS RULES AND PROCEDURES: I hereby understand and acknowledge that as a parent/guardian of a Fairview Titans Jr. Youth Football Program participant it is my responsibility to comply with all rules and regulations stipulated, adopted or recognized by the  Fairview Titans Jr. Youth Football Program or any of its member organizations and understand that any non-compliance with any and all rules and regulations may be cause for discipline and/or dismissal of the participant, myself, and/or any spectators or other persons affiliated with the undersigned and the above named participant. I agree to furnish an authentic certified copy of a birth certificate of the above-named participant to the Fairview Titans Jr. Youth Football Program officials and understand that valid proof of age and this form must be presented by date of certification in order to participate further in Fairview Titans Jr. Youth Football Program activities. I/We hereby hold Fairview Titans Jr. Youth Football Program harmless of any financial loss as the result of any disciplinary action.


12. STUDENT ATHLETE & PARENT/LEGAL GUARDIAN CONCUSSION STATEMENT: I am aware of the following information: A concussion is a brain injury which should be reported to my parents, my coach(es) or a medical professional if one is available. A concussion cannot be “seen.” Some symptoms might be present right away. Other symptoms can show up hours or days after an injury. I will tell my parents, my coach and/or a medical professional about my injuries and illnesses. I will not return to play in a game or practice if a hit to my head or body causes any concussion-related symptoms. I will/my child will need written permission from a health care provider* to return to play or practice after a concussion. Most concussions take days or weeks to get better. A more serious concussion can last for months or longer. After a bump, blow or jolt to the head or body an athlete should receive immediate medical attention if there are any danger signs such as loss of consciousness, repeated vomiting or a headache that gets worse. After a concussion, the brain needs time to heal. I understand that I am/my child is much more likely to have another concussion or more serious brain injury if return to play or practice occurs before the concussion symptoms go away. Sometimes repeat concussion can cause serious and long-lasting problems and even death. I have read the concussion symptoms on the Concussion Information Sheet. *Health care provider means a Tennessee licensed medical doctor, osteopathic physician or a clinical neuropsychologist with concussion training.

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Fairview Titans Jr. Pro Football Program

PO Box 1376 
Fairview, Tennessee 37062

Email Us: [email protected]
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