This on-line registration form will get you signed up for Flag Football for the Fall season. You will be re-directed to PayPal for payment.
We will contct you with additional information prior to the season starting!
Athlete (Child) Last Name(*)
Athlete (Child) First Name(*)
Birth Date (Numbers only - 01012011)(*)
Age as of June 1st of the current year(*)
Home Phone Number (Numbers Only no dashes)(*)
Parent 1 Primary Phone Number(*)
Parent 1 Alternate Number(*)
Parent 1 is(*)
Parent 2 Primary Phone Number
Parent 2 Secondary Number
Parent 2 is
Parent 3 Primary Phone Number
Parent 3 Secondary Number
Parent 3 is
Please include an email address where we can contact you with information about the Junior Packers.
For Emergency Purposes only, Please list any medical conditions or medication currently being taken by the child:
If a parent or guardian is unable to be reached in the event of an emergency, please provide an emergency contact:
Emergency Contact 1 Last Name(*)
Emergency Contact 1 First Name(*)
Emergency Contact 1 Primary Phone Number(*)
How did you hear about the Junior Packers program?
The Junior Packers are always looking for quality coaches to assist with teaching our student athletes.
Are you interested in coaching with the Junior Packers?
Please list any coaching experience you have
The Junior Packers have some volunteer oportunities (example: concessions at games)
Are you interested in volunteering for the Junior Packers?
Please list any volunteer experience or area you would be willing to help.
I, parent or guardian of the above named candidate for the Junior Packers team, hereby give approval for his/her participation in any and all team or league activities during the current season. I assume all risk and hazards incidental to such
participation including transportation to and from the activities; and to hereby waive, release, absolve, indemnify, and agree to hold harmless the local league, Omaha STORM dba The Junior Packers, the organizers, sponsors, supervisors, coaches and persons transporting my son/daughter to
and from the activities for any claims arising out of an injury to my son/daughter except for the amount covered by accident or liability insurance, if any carried by the team. In event the team travels, I give permission for my son/daughter to travel with them.
I do not hold the organization responsible for any injury or damage or loss while traveling.
The above names child is medically cleared to participate in sporting activities. If a parent or legal guardian is not present I grant permission to the team or league personnel to authorize and obtain emergency medical care olicensed physician, hospital, or medical clinic should my son/daughter become ill or injured while participating in team activities.
I agree upon request to return all equipment clean and in as good as condition as received, except for normal wear. If I do not return this equipment, I agree to pay for all equipment in the amount of $300. I also understand that Junior Packers is a non-profit 501(c)3 organization and as such, refunds are not given.
Please type your full name; indicating that you have read and agree with the above terms(*)
Please click to verify and continue.(*)
Flag Football - 55.00 USD
Early Signup Special - Total for the fall session is $55.00
Enter any dollar amount to make an additional Tax Deductible donation to the Junior Packers.
You will be redirected to PayPal for payment.