Please complete all fields and pay at the end

RM_Stats

PLAYER INFORMATION

Gender^*

Player First Name^*

Player Last Name^*

Player DOB^*

Please contact us before you register if you are not sure if you are eligible to play!

Player Age^*

Cannot be age 13 ON or BEFORE Dec 31. Must be between age 5 - 12

Player Address

Player City

Player State

Player Zip

Player Cell Number

Player Home Phone

School^*

Grade 2025/2026 School Year^*

Cannot be in 7th Grade

Parent/Guardian #1 Information

P/G #1 First Name^*

P/G #1 Last Name^*

P/G #1 Email^*

P/G #1 Address^*

P/G #1 City^*

P/G #1 State^*

P/G #1 Zip^*

P/G #1 Home Phone

P/G #1 Cell Phone^*

P/G #1 Relationship to Player^*

Parent/Guardian #2 Information

P/G #2 First Name

P/G #2 Last Name

P/G #2 Email

P/G #2 Address

P/G #2 City

P/G #2 State

P/G #2 Zip

P/G #2 Home Phone

P/G #2 Cell Phone

P/G #2 Relationship to Player

Emergency Contacts:

MUST have at least two contacts besides the Parents/Guardians listed above!

E-Contact #1 Full Name^*

E-Contact #1 Cell Phone Number^*

E-Contact #1 Relationship to Player

E-Contact #2 Full Name^*

E-Contact #2 Cell Phone Number^*

E-Contact #2 Relationship to Player

PHOTO RELEASE:

I authorize YPAC to take photographs during the season and post those photographs on the YPAC Facebook site as well as future use on the YPAC website.

Photo Release^*

***YOU MUST SCROLL & READ EACH PARAGRAPH BEFORE YOU ARE ABLE TO SELECT THE CHECK BOX***

Parent Code of Conduct & Player Code of Ethics^*

We certify that we have read the "Players Code of Ethics" & "Parents Code of Conduct" located under the "Parent/Player Info" tab located at www.ypacsports.com and we agree with the Code & Ethics rules of YPAC.  We understand that we can be removed or banned from games for violating these rules.

We Certify

Refund Policy^*

Once game uniforms have been ordered, there are NO REFUNDS for any reason! Any refund issued before uniforms are ordered will be minus a $3.20 processing fee. All issued gear must be turned in first. Refunds will be issued through PayPal only to the CC used to pay during registration.  This policy will also apply if the season is cancelled after starting due to COVID-19.

I AGREE

***YOU MUST SCROLL & READ EACH PARAGRAPH BEFORE YOU ARE ABLE TO SELECT THE CHECK BOX***

Parent/Guardian Consent^*

The information on this form will be kept confidential and used as a quick reference in the event of a medical situation.  I understand it is my responsibility to notify Youth Pacers Athletics Corporation (YPAC) Staff if any of the information on this form changes during the football season. I hereby certify by signing below that the player listed above is in good health and is capable of participating safely in the tackle football program of the YPAC. The undersigned agrees to indemnify and hold harmless YPAC, its Successor and Assigns, YPAC Board Officers, Directors, Coaches/Assistant Coaches, Volunteers, Shareholders, Employees, Agents, their Heirs, Executors and Administrators as well as the Switzerland County School Corporation. I understand that every effort will be made to contact the primary and secondary emergency contacts on this form if time permits. I do hereby authorize any of the YPAC Staff to give advice and give consent with regard to the medical care and treatment of my player to emergency room physicians or to provide treatment in the event of an injury to my player in my absence.

I AGREE

Registration Fee^*

ONLY CLICK SUBMIT ONCE!! Please wait until the info is submitted and you will be taken to the PayPal page automatically. It could take up to 1 minute depending on your internet speed!

Select a payment method^*

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