2021 FOOTBALL & CHEERLEADING REGISTRATIONS
Welcome to the 2021 Whippets Football & Cheerleading registration portal! Please complete all online registration forms. Payment is required at the end of the online registration process. You can register up to 4 participants online.
2021 FEE CHART:
$30 - for first child
$15 - for second child
$10 - for third child
FREE - for fourth or more children
​
*In addition to all registration forms - WE WILL NEED A COPY OF YOUR CHILD'S BIRTH CERTIFICATE AND YOUR CHILD'S 2021 COMPLETED PHYSICAL FORM. Both forms can be uploaded during this online registration, mailed, or brought to us during one of our in person registrations. PRACTICES FOR FOOTBALL & CHEER WILL BEGIN JULY 12.
PARTICIPANT INFORMATION
FIRST NAME
MIDDLE INITIAL
LAST NAME
SUFFIX
DATE OF BIRTH
AGE ON AUGUST 1, 2021
SPORT TYPE
address
GUARDIAN INFORMATION
GUARDIAN 1 FULL NAME
RELATIONSHIP TO PARTICIPANT
CELL PHONE NUMBER
EMAIL ADDRESS
(optional)
GUARDIAN 2 FULL NAME
RELATIONSHIP TO PARTICIPANT
CELL PHONE NUMBER
EMAIL ADDRESS
emergency contact INFORMATION
EMERGENCY CONTACT
EMERGENCY PHONE NUMBER
medical history
PLEASE ANSWER THE FOLLOWING QUESTION.
WITHIN THE PAST YEAR HAS THE PARTICIPANT BEEN TREATED FOR ANY OF THE FOLLOWING?
PLEASE CHECK ALL APPLICABLE BOXES. YOU MUST GIVE AN EXPLANATION FOR ALL CHECKED BOXES BELOW
Asthma
Concussion
Hernia
Knee Injury
Joint Injury
Heat Exhaustion
Dizziness
Fainting Spells
Shortness of Breath
Broken Bones
Neck Injury
Head Injury
Allergies
Epileptic Seizures
Diabetes
Heart Conditions
Does the participant currently take medication(s)?
Does the participant currently wear eyeglasses?
Does the participant currently wear contact lenses?
INSURANCE INFORMATION
Having been informed of the organization, the Wyoming Valley Junior Football Conference Inc., to provide supervised activities during the season, I do assume all the risk and hazards incidental to the conduct of the activity and I do further release, absolve, indemnify, and hold harmless the Wyoming Valley Junior Football Conference Inc., the organizers, sponsors, or any of the supervisors appointed by them. I likewise release responsibility to any person transporting my child to and from an activity. As the guardian, I will furnish, upon request of the conference by-laws, a certified copy of the birth certificate of the above-named candidate and current sports physical. The Insurance that the Wyoming Valley Junior Football Conference Inc., carries is only secondary insurance. Please be advised that your Family Insurance is the Primary Insurance Coverage in case of Injury.
PLEASE COMPLETE BELOW
MY CHILD
INITIALS
INSURANCE CARRIER
HOSPITAL OF CHOICE IN NON-EMERGENCY TREATMENT IS:
INSURANCE PLAN
INSURANCE GROUP #
confirmation of information
I agree to the above and affirm that the above answers are accurate and represent an overall general state of my child’s health. In the event of injury to my child, I hereby give the ambulance association, any licensed care provider or facility, permission to treat my child, and to do all and anything that is medically necessary for the treatment of my child including transportation to the nearest hospital for emergency treatment and any and all treatment that is necessary.
ATTENTION ALL PARENTS, GUARDIANS AND FANS
If a fan(s) become(s) unruly or disruptive during a Wyoming Valley Junior Football Conference Inc game, the game will be stopped until the fan(s) calm down or are removed. If the fan(s) do not calm down or resist removal from the venue, the league official has the authority to terminate the game.
PARENT/GUARDIAN SIGNATURE
DATE
INTERESTED IN COACHING?
Interested in coaching this season? Please fill out a coaching application and we will contact you.
STAY IN THE LOOP
TEXT NOTIFICATIONS
Always stay in the loop with the Remind App! Join the app today.
HOW TO GET THE APP:
1. Download the REMIND APP on your smart phone from the App Store.
2. Once downloaded, join our group fwfb.
3. You're all set!
EMAIL NOTIFICATIONS
JOIN OUR NEWSLETTER FOR ALL EMAIL NOTIFICATIONS
If the page does not let you advance, one or more fields are filled out incorrectly. Please check anything in red.