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E.H.T.Y.O.
Egg Harbor Township Youth Organization
Registration Form
Please Provide the Following Information:                

First Name:     Middle Initial:
Last Name:    Date Of Birth:
Address: City:   Zip Code:
Age:                Grade:  Home Phone:
Height: Weight: Lbs
Activity:Football  Cheerleading  Drill Team

League Played Previously:Atlantic  Cape Atlantic
Work Phone Number: Emergency Phone Number:

PROGRAMS SUCH AS THESE ARE POSSIBLE ONLY THROUGH THE VOLUNTARY EFFORTS OF CONCERNED PARENTS.  Please check off below where you will be able to help out to meet your obligation to meet your obligation to see that these programs continue.        PARENTS AND GUARDIANS PLEASE UNDERSTAND THAT THERE IS A MANDATORY FUNDRAISER

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Coach/Assistant Coach
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Cheerleader Coordinator
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Football Coordinator
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Refreshment Stand
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Ceremonies Committee
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Home Coming Committee
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Banquet Committee
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Booster Club

I, the parent of the above named individual, hereby give my approval to his/her participation in the above activity.  I assume all the risks and hazards incidental to such participation, including transportation to and from the activity, and I do hereby waive, release, absolve indemnify and agree to hold harmless the Township of Egg Harbor, Softball/Baseball Association, EHT Street Hockey Association, EHT Soccer Club, EHT South Jersey Competition Cheerleaders and any other recognized groups, it's organizers, sponsors, supervisors participates and persons negligence or for any other cause, except to the extent and the amount covered by the excess coverage insurance provided by the Township of Egg Harbor.

I further agree to return the uniform and other equipment issued to my child in as good a condition as when received, except for normal wear that tear.  IF NOT RETURNED BY THE ENDO OF THE SEASON, THE CHILD WILL NOT BE ABLE TO PARTICIPATE IN ANY TOWNSHIP SPONSORED ACTIVITY.   I also agree to PAY THE FULL REPLACEMENT COST for said equipment/uniform in the event it is damaged, lost or stolen. When Completing Registration Form &  Attached Web Site Release Form Print (3) copies of both after setting Top, Bottom, Left & Right Margins to "0" (zero)

    _________________________________________
 Parent's/Guardians Name     (Please Print)                             Signature                                                Date      
__________________________________________________________________________________________

FOR ORGANIZATIONAL USE ONLY

$______________Amount Paid    Family Fee Cash   Check #  Birth Certificate Checked

___________________________     EQUIPMENT REPLACEMENT COST:
             Date                                               Revision: 11/91, 4/93,  9/97,  2/00,  2/01,  1/03,  3/08

E.H.T.Y.O. Web Site Release Form for Minors
Video/Photo/Audio Consent Form

I, the undersigned, do hereby consent to the use by E.H.T.Y.O. and George B. Kurtz Photographer, Image, voice, or both of the minor child under the age of 18 described
below, in (1) the video, photograph, or audio recording described below; and (2) any video, photograph, or audio recording reproduced either in whole or in part from the video, photograph or audio recording described below: regardless of whether these materials are used for Web Site, fundraising, advertising, publicity, or any other purpose on behalf of E.H.T.Y.O..

I warrant that I am the parent or legal guardian of the minor described below and have the full right and authority to grant this consent on behalf of such minor.

In addition, I waive all claims to compensation or damages based on the use of such minor’s image or voice, or both, by either E.H.T.Y.O. or E.H.T.Y.O.’s Web Site. I also waive any right to inspect or approve the finished photograph or video or audio recording.
 
I understand that this consent is perpetual, that I may not revoke it, and that it is binding on the minor, our heirs and assigns.

I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned. I further attest that I have read this consent form and fully understand its contents.

Photograph Category:        Football         Cheerleading       Drill Team


            Age of Student     Date of Birth
            (Printed name of Student)

 

           
                             Address                                                                   City                                              Zip

           ____________________________________     
Printed Name  of Parent/Guardian                    Signature of parent or legal guardian                    Date
 


George B. Kurtz  6524 Reega Ave. Egg Harbor Township, NJ  08234
Name and address of photographer/videographer

EHTYO 3/4/2008 Form