Forms

2022 PJYFL Registration is Open

Page 1

Password^*

Password must be at least 7 characters long.

Enter password again^*

Parent/Guardian First Name^*

Parent/Guardian Last Name^*

Parent/Guardian Contact Number^*

Parent/Guardian Email^*

Choose One^*

Football
Cheerleading
Other

Please select

Player's First Name^*

Player's Last Name^*

Home Phone Number^*

Mobile Number^*

Home Address^*

Street Number

Street Address

City

State

Country

Zip Code

Player's Email

Player's Date of Birth^*

Age as of 11/01/2022^*

Grade as of September 2022^*

School Attending (Please no abbreviations)^*

Any allergies, required medications, and/or medical/physical conditions? If so, please list:

Emergency Contact Name^*

Please list the name of the emergency contact.

Emergency Contact Phone Number^*

Terms & Conditions^*

I agree

I/We the parents/guardians of the above named candidate for a position on a youth football or cheerleading team, hereby give my/our approval to participate in any and all youth football or cheerleading activities. I/We assume all risks and hazards incidental to such participation including to and from the activities: and I/We hereby waive, release, absolve, indemnify and agree to hold harmless the OCYFL, PJYFL, the organizers, sponsors, managers, coaches, referees, league, board members, safety officer, announcer, committee members, timekeepers, supervisors, participants, and persons transporting my/our child to and from activities from any claim arising out of injury to my/our child whether the result of negligence or for any cause, except to the extent, and in the amount covered, by accident or liability insurance. BIRTH CERTIFICATE IS REQUIRED AND KEPT ON FILE WITH REGISTRATION. A SIGNED PARENT CODE OF CONDUCT AND A MEDICAL FORM SIGNED AND DATED BY PHYSICIAN FOR THE CURRENT YEAR ARE ALSO REQUIRED TO BE ELIGIBLE TO PARTICIPATE IN THE OCYFL / PJYFL.

Photo Release Agreement^*

I agree

The Port Jervis Youth Football League (PJYFL) and/or The Orange County Youth Football League (OCYFL) has my permission to use my or my child’s photograph, image, and/or likeness publicly to promote the PJYFL and/or the OCYFL. I understand the images may be used in print publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Consent of Fees^*

I agree

I/We the parents/guardians of the above named candidate for a position on a youth football or cheerleading team, hereby understand that I/we will be required to pay the below fees for my/our child/children on the day of equipment handouts. The fees are as follows: 

Football - $175.00/player
Cheerleading - $125.00/Cheerleader

Page 2

Parent/Guardian Code of Conduct The essential elements of character-building and ethics in sports are embodied in the concept of sportsmanship and six core principles: trustworthiness, respect, responsibility, fairness, caring, and good citizenship. The highest potential of sports is achieved when competition reflects these values. I therefore agree: 1. I will not force my child to participate in sports. 2. I will remember that children participate to have fun and that the game is for youth, not adults. 3. I will inform the coach of any physical disability or ailment that may affect the safety of my child or the safety of others. 4. I will learn the rules of the game and the policies of the league, including following By-Laws from town or league. 5. I (and my guests) 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 sporting event. 6. I (and my guests) 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; or using profane language or gestures. 7. I will not encourage any behaviors or practices that would endanger the health and well-being of the athletes. 8. I and or my family/friends will not place any derogatory statements about the youth football league, players, cheerleaders, coaches, (includes other towns in OCYFL) on any electronic communication device (examples – Web site, Facebook, Twitter, you-tube, text message, etc.) 9. I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence. 10. I will demand that my child treat other players, coaches, officials, and spectators with respect regardless of race,creed, color, sex, or ability. 11. 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. 12. I will praise my child for competing fairly and trying hard, and make my child feel like a winner every time. 13. I will never ridicule or yell at my child or other participant for making a mistake or losing a competition. 14. I will emphasize skill development and practice and how they benefit my child over winning. I will also de-emphasize games and competition in the lower age groups. 15. I will promote the emotional and physical well-being of the athletes ahead of any personal desire I may have for my child to win. 16. I will respect the officials and their authority during games and will never question, discuss, or confront coaches at the game field, and will take time to speak with coaches at an agreed upon time and place. (Follow 48 hr rule) 17. 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 sports events. 18. I will refrain from coaching my child or other players during games and practices unless I am one of the official coaches of the team. I also agree that if I fail to abide by any of the aforementioned rules and guidelines, I will be subject to disciplinary action that could include, but is not limited to the following: • Verbal or Written warning by official, head coach, and/or town or league official. • Parental game suspension with written documentation of incident kept on file by town or league involved • Revoked Member in Good Standing status with town • Parental season suspension • Parental ban from all PJYFL activities • Player game or season suspension Any Physical contact made by one person on another person at any OCYFL/PJYFL event will result in an immediate suspension pending an investigation by the board. Assault will be defined as a punch, kick, slap, spit, or any physical contact upon another person.

Medical Release Form - Download, complete, and bring with a copy of birth certificate and payment to equipment handout.

Parent/Guardian Code of Conduct Signature^*

I Agree

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2022 PJYFL Registration is Open

Page 1

Password^*

Password must be at least 7 characters long.

Enter password again^*

Parent/Guardian First Name^*

Parent/Guardian Last Name^*

Parent/Guardian Contact Number^*

Parent/Guardian Email^*

Choose One^*

Football
Cheerleading
Other

Please select

Player's First Name^*

Player's Last Name^*

Home Phone Number^*

Mobile Number^*

Home Address^*

Street Number

Street Address

City

State

Country

Zip Code

Player's Email

Player's Date of Birth^*

Age as of 11/01/2022^*

Grade as of September 2022^*

School Attending (Please no abbreviations)^*

Any allergies, required medications, and/or medical/physical conditions? If so, please list:

Emergency Contact Name^*

Please list the name of the emergency contact.

Emergency Contact Phone Number^*

Terms & Conditions^*

I agree

I/We the parents/guardians of the above named candidate for a position on a youth football or cheerleading team, hereby give my/our approval to participate in any and all youth football or cheerleading activities. I/We assume all risks and hazards incidental to such participation including to and from the activities: and I/We hereby waive, release, absolve, indemnify and agree to hold harmless the OCYFL, PJYFL, the organizers, sponsors, managers, coaches, referees, league, board members, safety officer, announcer, committee members, timekeepers, supervisors, participants, and persons transporting my/our child to and from activities from any claim arising out of injury to my/our child whether the result of negligence or for any cause, except to the extent, and in the amount covered, by accident or liability insurance. BIRTH CERTIFICATE IS REQUIRED AND KEPT ON FILE WITH REGISTRATION. A SIGNED PARENT CODE OF CONDUCT AND A MEDICAL FORM SIGNED AND DATED BY PHYSICIAN FOR THE CURRENT YEAR ARE ALSO REQUIRED TO BE ELIGIBLE TO PARTICIPATE IN THE OCYFL / PJYFL.

Photo Release Agreement^*

I agree

The Port Jervis Youth Football League (PJYFL) and/or The Orange County Youth Football League (OCYFL) has my permission to use my or my child’s photograph, image, and/or likeness publicly to promote the PJYFL and/or the OCYFL. I understand the images may be used in print publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Consent of Fees^*

I agree

I/We the parents/guardians of the above named candidate for a position on a youth football or cheerleading team, hereby understand that I/we will be required to pay the below fees for my/our child/children on the day of equipment handouts. The fees are as follows: 

Football - $175.00/player
Cheerleading - $125.00/Cheerleader

Page 2

Medical Release Form - Download, complete, and bring with a copy of birth certificate and payment to equipment handout.

Parent/Guardian Code of Conduct Signature^*

I Agree

2020 PJYFL Registration is Open

Parent/Gaurdian Email^*

Choose One^*

Football
CheerLeading

Please pick one

Player's First Name^*

Player's Last Name^*

Home Phone

Cell Phone^*

Home Address

Address Line 1

Address Line 2

City

State or Region

Zip

Child's Email^*

Date of Birth^*

Age as of 11/01/2020^*

Grade as of September 2020^*

School Attending (Please no abbreviations)^*

Any allergies, required medications, and/or medical/physical conditions? If so, please list:^*

Parent/Guardian First Name^*

Parent/Guardian Last Name^*

Emergency Contact Name^*

Emergency Contact Phone Number^*

Terms and Conditions^*

I agree

I/We the parents/guardians of the above named candidate for a position on a youth football or cheerleading team, hereby give my/our approval to participate in any and all youth football or cheerleading activities. I/We assume all risks and hazards incidental to such participation including to and from the activities: and I/We hereby waive, release, absolve, indemnify and agree to hold harmless the OCYFL, PJYFL, the organizers, sponsors, managers, coaches, referees, league, board members, safety officer, announcer, committee members, timekeepers, supervisors, participants, and persons transporting my/our child to and from activities from any claim arising out of injury to my/our child whether the result of negligence or for any cause, except to the extent, and in the amount covered, by accident or liability insurance.BIRTH CERTIFICATE REQUIRED AND KEPT ON FILE WITH REGISTRATION. A SIGNED PARENT CODE OF CONDUCT AND A MEDICAL FORM SIGNED AND DATED BY PHYSICIAN FOR THE CURRENT YEAR ARE ALSO REQUIRED TO BE ELIGIBLE TO PARTICIPATE IN THE OCYFL / PJYFL.

Registration Fee^*

Because we are not certain if we will have a season, at this time we are not accepting payments. Please continue to register your child so we can assess interest in 2020 participation.

Payment will be due at equipment handout