Player Name *

First Name

Last Name

PARENT OR GUARDIAN CONSENT *

I, the parent or guardian of the above named player participating in the Great Plains Youth Football League, hereby give my approval for his/her participation in any and all team or league activities during the current season. I assume all risk and hazards incidental to such participation including transportation to and from activities. Any player participating in the Great Plains Youth Football League who has a pre-existing condition, been diagnosed with a pre-existing condition, or believes they may have a pre-existing condition, must provide Great Plains Youth Football with a medical release note or form from a licensed medical physician in order to participate in games in the Great Plains Youth Football League. Pre-Existing conditions requiring a licensed medical physician’s release include, but are not limited to, asthma, head injury or concussion, immune system deficiency, diabetes, heart problems, Hemophilia, multiple sclerosis, or any injury or health condition which occurred prior to the start of practices or games, among others. I understand that, as the parent or guardian of the below named player, I am responsible for reporting, obtaining medical release documents and providing the Great Plains Youth Football League with medical release information pertaining to any pre-existing condition of the below named player. It is the duty and responsibility of the parent/guardian of participant to provide a medical release to the Great Plains Youth Football. All information provided will be held confidential by the Great Plains Youth Football League and only those officials, including the Great Plains Youth Football League Board of Directors, the player's team coach and the local Program Leader, will be made aware of pre-existing conditions. This is to help ensure the safety and well-being of your child. By consenting to this section of this form, I hereby waive, release, absolve, indemnify and agree to hold harmless the Great Plains Youth Football League, all program members, all officials, directors, organizers, coaches, and all board members of Great Plains Youth Football and member programs, including program member and organization leaders, administrators, directors, coaches, USA Football and Heads Up Football, LLC., of any liabilities and any and all injuries suffered by my child or any children that I have legal guardianship over through their participation in the Great Plains Football League. I agree to and grant permission to the team or league officials of the Great Plains Youth Football League to authorize and/or obtain medical care from a licensed medical personal, physician, hospital or medical care center (in my absence) should the player become ill or injured while participating in team or league activities. I grant permission to the commissioners of the league to obtain proof of age for my player from school records and/or bureau of vital statistics. I understand that Great Plains Youth Football does not provide Health Insurance for my child and that I am responsible for providing health insurance coverage and am responsible for any and all medical costs in the event of injury or illness to my child.

I CONSENT

I DO NOT CONSENT

WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19 *

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate on behalf of the Great Plains Football League and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence and the releases or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4 I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, release and hold harmless Great Plains Football, their officers, officials, other participants, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), with respect to any and all illness, disability, death, or loss or damage to person or property, whether arising from the negligence of releasees or otherwise, to the fullest extent permitted by law.

I AGREE

I DISAGREE

PARENT PLEDGE AGREEMENT *

The Head Coach for each team is responsible for the actions of his or her coaching staff and the parents and family members of their players. The game officials will not respond to anyone on the field or in the stands except the Head Coach. Great Plains Youth Football requires parents and spectators to act with dignity, maturity and integrity while a spectator at a Great Plains Football sponsored event or activity. Parents and spectators are expected to act as support mechanisms for the children on the field and are encouraged to cheer for all the players, coaches and officials. Parents and spectators are not allowed to make unsportsmanlike comments, profanities, complaints, or gestures, toward any coaches, players, officials or league representative while attending any Great Plains Youth Football sponsored events. If an official feels they are being treated in an unsportsmanlike manner by a coach or a spectator, a penalty will be enforced and a 15-yard personal foul penalty will be assessed. At this point the Head Official will communicate to the Head Coach of the team violating the Parent Pledge Agreement why the penalty was assessed and stop the game clock for 1 minute so the Head Coach can address the problem. After 1 minute has elapsed, the Head Official will again talk to the Head Coach of the team violating the Parent Pledge Agreement to make sure the problem has been addressed. If a second penalty occurs for the same team, regarding the same parent or spectator within the same game, the spectator will be removed from the game and the game suspended until the parent or spectator has left the field area. If another infraction occurs during the same game, the team violating the Parent Pledge Agreement will immediately forfeit the game. Additionally, any parent or spectator ejected from a game will not be allowed to attend that team’s next league game. Spectator Concerns, Issues and Complaints: as a parent, spectator or relative with a child participating in the league, if you have an issue, the following protocol must be followed: Step #1, contact your teams Head Coach. If your teams Head Coach cannot resolve your issue then please move to Step #2, which is to contact the teams local Program Leader about your concerns or issues. If the Program Leader cannot resolve your concerns or issues, then, Step #3 would be to approach the GPYF Board of Directors via email or phone call from your local Program Leader. The league will only accept concerns and/or complaints that are sent, in writing, from the Program Leader, who is the designated point of contact between your program and Great Plains Youth Football. We have several thousand parents involved in the league, so the league is not able to hear, read or respond to grievances, complaints, issues or concerns that have not followed the proper steps. Furthermore, the league will not hear or respond to complaints regarding officials, official’s calls or non-calls. Any spectator that fails to abide by this protocol may be subject to disqualification of attending future events. If at any time a spectator approaches a game official or opposing coach, regardless of the content of their words or actions, the spectator will be ejected immediately. The spectator will be suspended for a minimum of one game and potentially a life-time ban, based off of the severity of the situation. Our game officials and coaches are off-limits to all spectators at all times. NO EXCEPTIONS! By agreeing to this section of the form, I understand the Parent Pledge Agreement, agree to its’ terms and the severity of the punishment to my child’s team.

I AGREE

I DISAGREE

CONCUSSION AWARENESS EDUCATION *

In accordance with Nebraska Statute #LB260 and Iowa Section Code 280.13c, Great Plains Youth Football is required to provide concussion awareness information and educational materials to each player and their parent/legal guardian. Great Plains Youth Football has placed educational information meeting these requirements on our league website at www.greatplainsfootball.com. By signing this form, I hereby agree to access this information to become educated about concussions, symptoms, treatments and causes and return to play requirements. I also hereby agree that if I, a coach, or league official suspects that my child has suffered a concussion, I will provide a signed medical release statement from a licensed physician before my child is allowed to participate in further conditioning, practices or games in the Great Plains Youth Football League.

I AGREE

I DISAGREE

FOR PARTICIPANTS OF MINORITY AGE *

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, even if arising from their negligence, to the fullest extent provided by law.

I have read this release of liability and assumption of risk agreement, fully understand its terms, and sign freely and voluntarily without any inducement.

I have no idea what I am doing... I never learned to read.

VOLUNTEER PLEDGE *

I hereby pledge that at a minimum one member of my family will volunteer to work 1 Jr Vikings game during the 2024 season in one of the following positions: - Concessions Volunteer - Score Board Operator - Chain Gang I hereby give a deposit of $50 and a promise to work one of the above positions. Should I not fulfill my volunteer duties, Waverly Eagle Jr Vikings will not issue a refund per end of season policy, and cash said check (if applicable) for the full amount of the deposit. Upon completion of my duties, I will have the deposit check returned to me, or refunded if paid through a different form of payment, at the end of the year.

I AGREE

I DISAGREE

Parent /Guardian Name 1: *

First Name

Last Name

Parent /Guardian 1 Phone: *

(###)

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Parent /Guardian Name 2:

First Name

Last Name

Parent /Guardian 2 Phone:

(###)

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Date of Consent\Agreement *

MM

DD

YYYY