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2026 East Dubuque Youth Football League Registration

PROGRAM PARTICIPATION FEE - $65

DEADLINE: AUG. 15, 2026

Player Information

Player Name:

Date of Birth:

Players Grade (2026-27 School Year)

Parent/Guardian Information

Parent/Guardian Name:

Phone Number:

Email Address:

Emergency Contact

(Different from parent/guardian if possible)

Name

Phone Number

Relationship to Player

Medical Information

Allergies or Medical Conditions

Medications

Doctor’s Name & Clinic

Concussion Information

1. Definition of a Concussion

A concussion is a type of traumatic brain injury (TBI)caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes and sometimes stretching and damaging brain cells.

2. Common Signs and Symptoms

Athletes do not have to "black out" to have a concussion. Signs and symptoms can show up immediately or hours later.

Signs Observed by Staff/ParentsSymptoms Reported by AthletesAppears dazed or stunnedHeadache or "pressure" in headConfused about assignment/positionNausea or vomitingForgets an instructionBalance problems or dizzinessMoves clumsily or answers slowlyDouble or blurry visionLoses consciousness (even briefly)Sensitivity to light or noiseShows mood or behavior changesFeeling sluggish, hazy, or foggyCannot recall events before or after hitConcentration or memory problems

3. "Danger Signs" (Seek Immediate Emergency Care)

If an athlete develops any of the following after a hit, call 9-1-1 or go to the emergency department immediately:

One pupil larger than the other.

Drowsiness or inability to wake up.

A headache that gets worse and does not go away.

Slurred speech, weakness, numbness, or decreased coordination.

Repeated vomiting or nausea, convulsions, or seizures.

Unusual behavior, increased confusion, restlessness, or agitation.

4. Mandatory Action Plan

Remove from Play: If a concussion is suspected, the athlete must be removed from play immediately.

Keep Out of Play: An athlete should not return to play the same day as the injury.

Medical Clearance: The athlete may only return to play with written permission from a healthcare provider experienced in evaluating concussions.

Standard Waiver Agreement Language

You may include a signature section like this to confirm compliance:

Parent/Guardian Agreement: I have read the CDC Concussion Fact Sheet and discussed the risks of concussion with my child. I understand that if my child is suspected of having a concussion, they will be removed from play and cannot return until cleared in writing by a qualified healthcare professional.

Athlete Agreement: I have learned about concussions and agree to report any symptoms I have—or that I see in my teammates—to my coach or parents immediately.

EDYFL Parents Rules and Regulations Contract

I agree to follow all E.D.Y.F.L. Rules and Regulations.

I accept full financial responsibility for all equipment issued to my child and agree to pay for, or replace, lost or stolen equipment in my care current season. I will return all equipment to E.D.Y.F.L. on equipment turn in day at the end of the current season.I / We will work at least one function through the season.

I agree that if I have any issues pertaining to coaches, referees, or any other parents during practices or games to take these issues to the coach, or President of E.D.Y.F.L – AFTER practices or games.

I agree that if my actions at games and practices are in any way un-sportsman like or unbecoming of a E.D.Y.F.L parent, the following disciplinary actions will be enforced.

1st Offense with confirmation: Parent is warned by coach or board member.

2nd Offense with confirmation: Parent will be asked by coach or board member to leave the field.

3rd Offense with confirmation: Participating child will be dismissed from the game in session or next game.

4th Offense with confirmation: Parent will no longer allowed at games or practices

Electronic Signature:*

EDYFL Parents Rules and Regulations Contract

I/We have read, understand and agree to comply with the Parents Rules and Regulations Contract as outlined above.

EDYFL Parents Rules and Regulations Contract

In consideration of being allowed to participate in any way in the East Dubuque Youth Football League, also known as E.D.Y.F.L. athletic sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent injury and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

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,

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual 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,

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS East Dubuque Youth Football League their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE.

Electronic Signature:*

I/We have read, understand and agree to comply with the Parents Rules and Regulations Contract as outlined above.

I, PERSONALLY AND ON BEHALF OF MY CHILD, HEREBY GIVE RELEASEES, OR ANY ONE OF THEM, PERMISSION TO USE MY AND/OR MY CHILD’S NAME, PHOTOGRAPH, QUOTATIONS AND LIKENESS IN ANY ADVERTISEMENTS OR PROMOTIONS PERFORMED IN CONNECTION WITH THE E.D.Y.F.L. AND AGREE THAT NEITHER I NOR MY CHILD SHALL BE ENTITLED TO ANY COMPENSATION FOR SUCH USE.

I agree to the above statement:

I AGREE