Rec Football Registration Online Payment Due August 7th 2026 $65 Contact Information Child's First Name (required) Child's Last Name (required) Date of Birth (required) Street Address (required) City (required) State (required) Childs grade (required)3rd 4th 5th 6th Gender (required)Male Female List any medical problems/allergies (required) Family Doctor (required) Guardian #1 First and Last Name (required) Guardian #1 Phone Number (required) Email Address (required) Guardian #2 (if applicable) First and Last Name Guardian #2 (if applicable) Phone Number Emergency Contact (required) Emergency Contact Phone Number (required) Liability Is child covered under medical insurance? (required)Yes No What company insurance, if covered? (required) I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of Worland Youth Football. Recognizing the possibility of physical injury associated with tackle football, I, hereby release, discharge and/or otherwise indemnify the Worland Recreation District and their associated personnel, including the owners of fields and facilities utilized for the Programs, against any claims by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. CONSENT FOR MEDICAL TREATMENT As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. (required)Yes No Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures Pay Now
