YMCA of SuperiorCalifornia

Yolo County Service AreaSummer Dodgeball League

Name of Player______DOB ______Age______Gender ______Address______City______ZIP______

Email______

Grade _____ School______Home Phone #______

Mother’s/Stepmother’s name ______Cell Phone#______

Father’s/Stepfather’s name______Cell Phone#______

Emergency Contact______Phone #______

T-shirt size: (T-shirts run SMALL)

YS (size 6 – 8) ______YM (size10 - 12) _____ YL (14 – 16) ______

AS (size 16) ______AM (size 34-36) _____ AL (size 38-40) _____ AXL (size 42)

Special Request Policy: We will consider 1 special request per player. The requestmust be mutual and must be on both players’ registration forms. In addition, if you are registering late for the program special requests are not granted. Requests must be in the same age group. Requests are not guaranteed!

SPECIAL REQUEST______

***ATTENTION***

DODGE BALL LEAGUE IS COACHED BY YMCA STAFF AND TEAMS WILL NOT

HAVE PRACTICES BEFORE THE SEASON BEGINS.

GAMES WILL BE PLAYED FRIDAY EVENINGS STARTING JUNE 15 THROUGH AUGUST 3.

Member Fee $35 Non-Member Fee $50 [additional $15 late fee after May 25]

Would you like to donate money $5 or $10 to allow an economically disadvantaged youth to play?

If yes, please indicate amount below.

$______

Credit Voucher / Refund Policy

1: A credit / refund will be issued if the YMCA cancels a sports program.

2: A credit / refund minus a $10 service fee will be issued if an individual withdraws from the program.

3: A credit is only good for 6 months after issued.

Initial: ______Date: ______

YMCA of Superior California

Yolo County Service Area

PARTICIPANT

RELEASE and WAIVER of LIABILITY and INDEMNITY AGREEMENT

IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the YMCA (or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the YMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

1.THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the YMCA and all branches thereof, its directors, officers, employees, and agents (hereinafter referred to as "releasees") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence of the releasees or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with the YMCA.

2.THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any, loss, liability, damage or cost they may, incur due to the presence of the undersigned or such children in, upon or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releasees or otherwise.

3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR

PROPERTY DAMAGE to the undersigned or such children due to negligence of releasees or otherwise while

In about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment

thereon or participating in any program affiliated with the YMCA.

4. I hereby authorize the YMCA to take pictures of my child for the sole use of marketing purposes.

THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made.

I HAVE READ AND UNDERSTAND THIS DOCUMENT AND RELEASE

Date: ______Signature of parent/guardian______

Program Activity______

YMCA PARENT CODE OF CONDUCT

Preamble
The essential elements of character-building and ethics in sports are embodied in the concept of sportsmanship and the Four YMCA core values: Honest, Respect, Caring, and Responsibility.

I therefore agree:
1. I will not force my child to participate in sports.
2. I will remember that children participate to have fun and that the game is for youth, not adults.
3. I will inform the coach of any physical disability or ailment that may affect the safety of my child or the safety of others.
4. I will learn the rules of the game and the policies of the league.
5. I (and my guests) will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy, and by demonstrating positive support for all players, coaches, officials and spectators at every game, practice or other sporting event.
6. I (and my guests) will not engage in any kind of unsportsmanlike conduct with any official, coach, player, or parent such as booing and taunting; refusing to shake hands; or using profane language or gestures.
7. I will not encourage any behaviors or practices that would endanger the health and wellbeing of the athletes.
8. I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence.
9. I will demand that my child treat other players, coaches, officials and spectators with respect regardless of race, creed, color, sex or ability.
10. I will teach my child that doing one's best is more important than winning, so that my child will never feel defeated by the outcome of a game or his/her performance.
11. I will praise my child for competing fairly and trying hard, and make my child feel like a winner every time.
12. I will never ridicule or yell at my child or other participant for making a mistake or losing a competition.
13. I will emphasize skill development and practices and how they benefit my child over winning. I will also deemphasize games and competition in the lower age groups.
14. I will promote the emotional and physical well-being of the athletes ahead of any personal desire I may have for my child to win.
15. I will respect the officials and their authority during games and will never question, discuss, or confront coaches at the game field, and will take time to speak with coaches at an agreed upon time and place.
16. I will demand a sports environment for my child that is free from drugs, tobacco, and alcohol and I will refrain from their use at all sports events.
17. I will refrain from coaching my child or other players during games and practices, unless I am one of the official coaches of the team.

I also agree that if I fail to abide by the aforementioned rules and guidelines, I will be subject to disciplinary action that could include, but is not limited to the following:

  • Verbal warning by official, head coach, and/or head of league organization
  • Written warning
  • Parental game suspension with written documentation of incident kept on file by organizations involved
  • Parental season suspension

Parent/Guardian Signature ______