2013 CO-ED FLAG FOOTBALL REGISTRATION FORM
Player’s Name: ______M____ F____
Player’s D.O.B.:____/____/____ Grade: ______Shirt Size: ______
Sibling in Same Age Group? Yes ___ No ___ Name: ______
Parent/Guardian Names: ______
Street Address: ______City:______Zip: ______
Mailing Address: ______City: ______Zip:______
Cell Phone: ______Text (Y/N) ___ Home Phone: ______
Email: ______
Emergency Contact Name: ______Phone: ______
Doctor Name:______Doctor Phone:______
Insurance Name:______Policy Number: ______
***WE NEED COACHES-ARE YOU WILLING TO COACH?***
Name ______Email: ______Phone: ______
Registration Fee $60
***2nd Child and on receive $5.00 off Registration Fee (does not apply to late registration)***
There is a $10.00 late registration fee per player
Payment Policy: Orting Parks and Recreation offers families to pay by Cash, Check, Debit or Credit. Payment by Debit will be charged a processing fee of $1.00 plus the registration fee. Paying by Credit Card will be charged a $2.00 processing fee plus the registration fee. All returned checks must be paid in cash and will accrue a $40.00 NSF fee in addition to amount of the original check.
*For Official Use Only*
AMOUNT PAID: $______CASH CHECK# ______DEBIT ($1.00 fee) CREDIT ($2.00 fee)
Player’s Name: ______Grade: ______
Complaints: Orting Parks and Recreation wants to make the best for every participant and their family and friends. I understand that I make any and ALL complaints that I may have in writing and submit them to the Orting Parks and Recreation Department at the above address. I understand and verbal complaints will not be considered. I also understand that there is a refund policy. By signing below, I agree to abide by all the above and that all above information is correct for my child. INITIALS _____
Equipment Care: I understand that I must take care of any and all equipment that is handed out for the player to be able to participate. I understand that I must return all equipment clean by the return date or I will be turned over to collections for the amount of replacement. INITIALS ______
Refund Policy: Orting Parks and Recreation encourages all participants to review activity schedules carefully, to avoid conflicts. Orting Parks and Recreation reserves the right to cancel programs/classes due to insufficient registration or other causes beyond our control; in which case a full refund will be given. Participant may withdraw from a program/class up to one week after start of program/class. In this case a $20.00 administration handling fee and charges for any equipment or supplies already ordered will be deducted, with 75% of the remainder will be refunded. No refunds will be issued after the first week of program/class. Refund requests must be made in writing to Orting Parks and Recreation Department. INITIALS ______
Parent/Guardian Waiver and Release: I hereby grant my full consent and authorization for the above-named minor child to engage in activities offered by the Orting Parks and Recreation Department. I certify that I am the parent or legal guardian of the above-named child; and that, in consideration of the City allowing this waive any claim or right of recovery I might have arising out of any injury, death, or damage this child may sustain as against the City of Orting, the Orting School District, the Orting Community Center, the Orting Lions Recreation Park, and its officials, employees and agents. I agree photographs may be taken of the above-named child during such activities and may be used for promotional purposes. INITIALS ______
Parent/Guardian Medical Consent: As the parent or legal guardian, I authorize Orting Parks and Recreation Department staff and to render first aid to the above-named minor child in the event of injury. Also, I authorize a licensed medical professional to examine this minor child and, in the event of injury, to render such care as he or she deems necessary for the treatment of such injury. I further authorize the Orting Parks and Recreation Department to send this child to the hospital or licensed medical professional most accessible in the event of an injury or accident. INITIALS ______
Concussion Form: I have read the Concussion Form, I will comply with what is it saying and notify the coach and the Orting Parks and Recreation Department if I feel my child has any signs of a concussion. I also understand that I must have a doctors note for the player to return back to participate in the sport. INITIALS ______
Parent/Guardian Signature: ______Date: ______
PLAYER CODE OF CONDUCT
(Must be signed by player)
Orting Parks and Recreation (OPR) strives to provide a positive and nurturing environment for all of its participants. Participants are asked to commit to the team as a team player, do their best and represent the Orting Parks and Recreation.
I, the participant, WILL HEREBY AGREE TO THE FOLLOWING:
· I WILL conduct myself, in a proper manner at all practices and games.
· I WILL always follow the basic rule of FAIR PLAY. I will respect the rules for the game, my opponents and the officials and their decisions. Everyone on the side lines will participate while on or off the field and I personally will maintain myself control at all times.
· I WILL be on time communicated by the coach to all practice/games ready to go.
· I WILL participate when in the game and at every practice to my full ability except for an illness, injury or school function. If a player must miss a practice/game he/she must notify their coach as soon as possible.
· SCHOLASTICES shall take precedence over the sport.
· I WILL NOT be critical of teammates and never discuss teammate’s abilities except to encourage good team play.
· I WILL take care and turn in any and all equipment that is assigned to me by the OPR Department.
· I understand this is a team sport. I am on a team and I will be a team player.
· I WILL respect all of my teammates, coaches, officials and my competitors.
· I WILL always listen to my coaches instructions.
· I WILL conduct myself in a dignified manner at all times, especially on “the road”. Each player represents the sport, the Orting Parks and Recreation Department, the TEAM and the Community.
Failure to follow this code of conduct may lead to disciplinary action in accordance to the rules of the Orting Parks and Recreation Department.
By signing below, I confirm that I have read and understand the above and will support the Orting Parks and Recreation Department in good sportsmanship at all times.
______/____/____
Player Name (please print) Player Signature Date
Sport Participating In: ______
PARENT/GUARDIAN CODE OF CONDUCT
(Must be signed by parent/guardian)
Orting Parks and Recreation (OPR) strives to provide a positive and nurturing environment for all of its participants. Parents/Guardians are integral parts of ensuring children have a positive and enjoyable experience with the OPR League. As a parent, you have the responsibility to help reinforce what the coaches teach; fundamentals, sportsmanship and the love of the game. The children will see you and the way you react to all situations. It is imperative that you conduct yourself and represent the Orting Parks and Recreation in the best possible way.
As an Orting Parks and Recreation Parent/Guardian, I WILL HEREBY AGREE TO THE FOLLOWING:
· I WILL conduct myself, my family members and guests in a proper manner at all practices and games.
· I WILL treat all participants with respect, being positive and constructive at all times to players and coaches.
· I WILL treat all umpires/refs with respect, recognizing that there are rules that involve judgment. I will not openly criticize the umpires or participants during the course of a game/practice.
· I WILL NOT use any abusive or profane language or gestures and will control my anger at all times.
· I WILL NOT consume any tobacco or alcohol products or curse in the presence of players.
· I WILL cheer positively, providing encouragement for members of both teams.
· I WILL assume all risks and hazards incidental to such participation, including transportation to and from any sporting event.
· I WILL support my child’s commitment to the team by assuring his/her attendance at practices/games. And will notify the coach if my child is unable to attend a game or practice. And also encourage my child to play by the rules, as well as, praise my child for playing hard.
· I WILL respect the private property of those living near areas of play, with regard to parking, noise, garbage and trespassing to retrieve balls.
· I WILL also agree to turn in any and all uniforms/equipment that belongs to the OPR at the end of the season or agree to pay in full for it, at an amount determined solely by the OPR.
· I WILL remember that my child plays the sport for his/her enjoyment and not mine.
· I WILL make any and ALL concerns about players, coaches, umpires, fields or anything aspect of the OPR that I may have in writing and submit them to the Orting Parks & Recreation Department at the above address. I understand any verbal complaints will not be considered.
· I also understand that there is a refund policy.
Failure to follow this Code of Conduct may lead to disciplinary action in accordance to the rules of the Orting Parks and Recreation Department.
By signing below, I confirm that I have read and understand the above and will support the Orting Parks and Recreation Department in good sportsmanship at all times.
______/____/____
Parent/Guardian Name (Please Print) Parent/Guardian Signature Date
Participant Name: ______Sport Participating In: ______
001.347.60.01.00 Updated 1/13/2013