Youth Football/Cheerleading
Please fill out the following information accurately. It is of absolute necessity that the Parks & Recreation supervisory staff has all medical information on your child/children in order for them to provide a safe setting for everyone. Your child's information will be kept confidential. If the medical information is not accurate or not provided, the Parks & Recreation staff cannot be held responsible for lack of medical treatment. If injury occurs, the Parks & Recreation staff will do whatever is necessary to ensure your child's well being. Without accurate medical information this is more difficult to ensure.
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Email *
Players Name *
Date of Birth *
GG
/
MM
/
AAAA
Age at Start of Season *
Grade at Start of Season *
Gender *
Program *
Parent/Guardian Name and Phone Number *
Please include your home, cell, and work phone number.
Parent/Guardian Name and Phone Number
Please include your home, cell, and work phone number.
Mailing Address *
City, State, Zip *
In case we cannot reach parents/guardians contact *
Must include name and home, cell, and work phone number.
In case we cannot reach parents/guardians contact *
Must include name and home, cell, and work phone number.
Shirt Size *
Is your child subject to or have a history of allergies: *
Check all that apply.
Obbligatorio
Is your child subject to or have a history of any medical: *
Obbligatorio
If you have checked yes to any of the above, please explain in full in the space provided.
Additional information regarding your child's hearing. *
Please check all that apply.
Obbligatorio
Additional information regarding your child's hearing. *
Obbligatorio
Payment
Please mail checks made out to Town of Liberty Parks and Recreation at 119 North Main Street, Liberty, NY 12754.

Football - Resident Fee: $70 | Non-Resident Fee: $80
Cheerleading - Resident Fee: $45 | Non-Resident Fee: $55

Your application will be finalized once the payment has been received.
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