CATARACT LITTLE LOOP FOOTBALL ASSOCIATION
P.O. Box 223, Niagara Falls, NY  14302

( ) Football   or   ( ) Cheerleading

Team:___________________                                    Birth Certificate:_____________

Name:___________________________  Birth Date:__________   Weight:_________
Address:__________________________________   Phone:____________________
Guardian Name:_____________________________   Guardian Phone:____________
___________________________________________________________________

I understand that all equipment issued to my child is the property of the C.L.L.F.A.  It must be returned on demand and failure to do so will result in legal action against me.  The cost for replacing equipment is as follows:

Helmet - $65.00,  Shoulder Pads - $45.00, Other Pads - $30.00, Rib Guards - $20.00, Cheerleading Skirt - $50.00, Cheerleading Sweater - $50.00

Initials:__________________________    Date:___________________

I understand that there are NO refunds after the first week of practice, except for medical or physical reasons, or bring cut from the squad, and then only if all equipment has been returned.

Initials:__________________________    Date:___________________

I understand the insurance coverage by C.L.L.F.A. is secondary and I must have primary coverage.  All claims must first be submitted to my own insurance coverage, then to C.L.L.F.A. insurer, and it will be subject to all deductibles and provisions that the policy states.

Initials:__________________________    Date:___________________

I understand that my chiuld will be asked to participate in fundraisers during the year.  I also understand that there will be TRY-OUTS.  All refunds will be make by check if your child does not make the team/squad.

Initials:__________________________    Date:___________________

I understand there will be an additional $30.00 service charge for all returned checks and that my child may not participate in any CATARACT activities until all monies owed to C.L.L.F.A. are paid in full.

Signature:__________________________    Date:___________________

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Child One - $75.00   -   Each additional child $65.00 each.

Amount Paid:  $__________________________    From:______________________________________

Raffle Ticket Numbers:   from_________ to__________

Authorized Signature of C.L.L.F.A._______________________________   Date:__________________

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