Equipment Sign Off

Glen Rock Junior Football Association Equipment Sign Off
Distributed by: ___________________________
Distributed Date Issued Returned Date Returned Replacement Value
Helmet         $150.00
Shoulder Pads         $125.00
Rib Pads         $50.00
Girdle Pads         $10.00
Thigh Pads         $10.00
Knee Pads         $10.00
Black Game Jersey #       $50.00
White Game Jersey #       $50.00
Practice Jersey #       $20.00
Girdle           $25.00
Pants         $25.00
Belt         $5.00
Uniform         $125.00
Pom Poms         $25.00
Equipment/Uniform Policy
I/We understand that the equipment/uniform used by our child is only loaned to them by the Glen Rock Junior Football 
Association. I/We will return the equipment when it becomes due at the end of the playing season, and any lost or 
unreturned equipment is the responsibility of our family. I/We hereby accept financial responsibility to reimburse the 
program for said equipment in the event the equipment is lost of otherwise  not returnd at the appointed time. I/We further 
understand the failure to return any item will result in paying the listed replacement value of the item to the GRJFA. I/We further
understand the failure to return all tackle football equipment will result in a fee of $500, failure to return cheer uniform will
result in a fee of $150, plus any costs and fees incurred by the GRJFA.  
Print Name:___________________________________ Date: _________
Sign Name : ___________________________________
GRJFA Representative Sign Off
By signing this form, I acknowledge that all equipment listed has been returned to the Glen Rock Junior Football Association
Sign Name : ___________________________________

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