2017 Soccer REGISTRATION FORM
CYA 2017 Soccer REGISTRATION FORM
PO Box 394 Epsom, NH 03234 www.chichesteryouth.com
Due July 15, 2017
Player’s Name: ______________________________________________________________________________________________ Parent(s)/Guardian’s Name: ___________________________________________________________________________________ Address:
_________________________________________________________________________________________________
Telephone#:
___________________
DOB:
___________________
Age:
__________________
CYA has permission to publish my child’s name: YES or NO
CYA has permission to publish my child’s picture: YES or NO
Grade for 2017 – 2018 school year: ___________
Email:
________________________________________
CYA will not sell or share any email addresses. These addresses are used for the sole purpose of notifying each player/parent of upcoming events, programs, or changes to CYA activities.
AGE GUIDELINES: ☐ U6 ☐ U8 ☐ U10 ☐ U12
Must not be age 6 as of August 1, 2017 (no children under the age of 4 as of August 1, 2017) 1st and 2nd graders 3rd and 4th graders 5th and 6th graders
REGISTRATION FEES
&
DAYS OF GAMES
$40.00 for U6 -------------- PRACTICES ON SATURDAY $45.00 for U8 -------------- GAMES ON MONDAY & SATURDAY $50.00 for U10 GIRLS --- GAMES ON TUESDAY & SATURDAY $50.00 for U10 BOYS ---- GAMES ON MONDAY & SATURDAY $50.00 for U12 GIRLS ---- GAMES ON WEDNESDAY & SATURDAY $50.00 for U12 BOYS ----- GAMES ON THURSDAY AND SATURDAY
With a $10 late fee, registrations will be accepted from until July 29th. Registrations will not be accepted after this time as time is needed to assess players, confirm coaching availability and assign teams. Final Team Rosters have to be submitted to the league for insurance purposes ***Player will not be issued a uniform, allowed to practice or take the field if the registration fee has not been paid ***
Checks payable to Chichester Youth Association Confidential Scholarships available: contact Deb LaCross, [email protected], 603-731-3399 Please check Shirt Size: Youth – SM ☐ MED ☐ LG ☐ Adult – SM ☐ MED ☐ LG ☐ XL ☐
Please check Short Size: Youth – SM ☐ MED ☐ LG ☐ XL ☐ I will provide black shorts for my child ☐
Socks CYA to provide socks ☐
Adult – SM ☐ MED ☐ LG ☐ XL ☐ I will provide black shorts for my child ☐
I will provide socks ☐
Your child will be expected to participate in all practices. Repeated, unexcused absences may mean your child sits during the next game. You should make every effort to inform the coach before a missed practice.
The placement of your child to a particular team will be determined by the coaches and the commissioner, the placement will be based upon providing all players a level of play that will enhance their athletic ability and provide them with a safe playing environment
Please list all medical information that the CYA should be aware of. Include information about physical or mental conditions, allergies, hearing or vision problems and all medication taken (especially those children who would carry medicine with them). This information will be provided only to the child’s coaches. Insurance Type/Carrier: __________________________________________________ Insurance#: __________________________ Emergency Contact/Phone: _______________________________________________ Relation to child: ______________________
Please write down any IMPORTANT MEDICAL INFORMATION about your child:
____________________________________________________________________________________________________________ ***It is required by the CYA that at least one parent or guardian of each child participating in the program shall work, at a minimum, one “shift” in helping to run the Snack Shack. And one parent from each team will be designated (hopefully volunteer) as the “team parent” who will be responsible for coordinating the Snack Shack coverage for their team. Please note that the successful operation of the Snack Shack is extremely beneficial to the financial stability of the CYA in providing recreational programs for the youth of Chichester. *** Also, please check any other area in which you feel you would like to assist: Fundraising ☐
Team Parent ☐
Field Maintenance ☐
Coaching ☐
Other: ______________
Come and join the Chichester Youth Association, we are always glad to have new members join us to help plan/organize/carryout our activities to benefit the youth of our community.
If you require any additional information, you may contact: Soccer Commissioner Todd Monterio at [email protected] Please mail the registration form, please mail to the following address: Chichester Youth Association P.O. Box 394 Epsom, NH 03234
CODE OF CONDUCT FOR CHICHESTER COACHES, ATHLETES, AND PARENTS The youth of our community should have an opportunity to play sports in a safe, family-friendly environment, conducive to building good sportsmanship, respect for others and encouraging the development of self-esteem. In an attempt to provide this opportunity to our youth, the Chichester Youth Association has adopted a Code of Conduct which will be enforced on our fields during practice and game play, as well as on the playing grounds of our opponents by our home team players and their families or friends. I. II. III. IV. V. VI.
VII.
Respect for Property: Whether at practice, at a home or an away game, players for the Chichester Youth Association are representatives of the Town of Chichester, and shall treat all grounds, benches, fences and other structures with respect. Littering of any kind will not be tolerated. Use of Obscene or Profane Language or Gestures: Any player, parent, guest, coach or official at any sports event using obscene or profane language or gestures, or racial, ethnic or sexual slurs will not be tolerated, and may be banned from attending future youth events. Fighting: Initiating, threatening & engaging in fights or scuffles are strictly prohibited. Accident / Incident Reports: Any necessary first aid beyond a simple bandage requires a report to be filled out within 24 hours and returned to a board member of the CYA. Coaches must fill out and sign an incident report if a child is injured during any CYA activity. Respect for Team Obligation: Any lateness or absence from practice or games has a negative effect on the team. While it is understood that circumstances sometimes arise, Coaches must be notified of any anticipated lateness or absence. Return of Uniforms: Uniforms, unless otherwise stated, are property of the CYA and must be returned at the end of the season in a timely manner. A replacement fee may be charged for returnable items not returned. HAVE FUN: Most importantly, the time our children spend playing and learning sports on our fields and within our organization should be fun and safe. Interaction between players, parents and coaching staff should be of a positive nature, without the pressure or expectations to perform beyond their abilities as learning children. Adherence to the above policies will help to ensure that our children are receiving beneficial experiences that will be with them for a
lifetime.
As a parent/guardian of the above named player, I give approval for my child to participate in any and all Chichester Youth League activities. I assume all risks and hazards incidental to such participation and waive, release, absolve, indemnify and agree to hold harmless the Chichester Youth Association (CYA) and the organizers, sponsors, officers, directors, coaches, participants, Town of Chichester, School system and person transporting our child to and from activities from any claim arising out of injury to our child, whether the result of negligence or any other cause, except to the extent of and the amount of the Association or League Insurance. I understand that transportation to and from league games, practices and functions is the responsibility of the parent/guardian. I also agree to hold my child, myself, and my guests accountable to the code of conduct. PARENT/GUARDIAN SIGNATURE: ____________________________________________ DATE: __________________
PO Box 394 Epsom, NH 03234 www.chichesteryouth.com
Due July 15, 2017
Player’s Name: ______________________________________________________________________________________________ Parent(s)/Guardian’s Name: ___________________________________________________________________________________ Address:
_________________________________________________________________________________________________
Telephone#:
___________________
DOB:
___________________
Age:
__________________
CYA has permission to publish my child’s name: YES or NO
CYA has permission to publish my child’s picture: YES or NO
Grade for 2017 – 2018 school year: ___________
Email:
________________________________________
CYA will not sell or share any email addresses. These addresses are used for the sole purpose of notifying each player/parent of upcoming events, programs, or changes to CYA activities.
AGE GUIDELINES: ☐ U6 ☐ U8 ☐ U10 ☐ U12
Must not be age 6 as of August 1, 2017 (no children under the age of 4 as of August 1, 2017) 1st and 2nd graders 3rd and 4th graders 5th and 6th graders
REGISTRATION FEES
&
DAYS OF GAMES
$40.00 for U6 -------------- PRACTICES ON SATURDAY $45.00 for U8 -------------- GAMES ON MONDAY & SATURDAY $50.00 for U10 GIRLS --- GAMES ON TUESDAY & SATURDAY $50.00 for U10 BOYS ---- GAMES ON MONDAY & SATURDAY $50.00 for U12 GIRLS ---- GAMES ON WEDNESDAY & SATURDAY $50.00 for U12 BOYS ----- GAMES ON THURSDAY AND SATURDAY
With a $10 late fee, registrations will be accepted from until July 29th. Registrations will not be accepted after this time as time is needed to assess players, confirm coaching availability and assign teams. Final Team Rosters have to be submitted to the league for insurance purposes ***Player will not be issued a uniform, allowed to practice or take the field if the registration fee has not been paid ***
Checks payable to Chichester Youth Association Confidential Scholarships available: contact Deb LaCross, [email protected], 603-731-3399 Please check Shirt Size: Youth – SM ☐ MED ☐ LG ☐ Adult – SM ☐ MED ☐ LG ☐ XL ☐
Please check Short Size: Youth – SM ☐ MED ☐ LG ☐ XL ☐ I will provide black shorts for my child ☐
Socks CYA to provide socks ☐
Adult – SM ☐ MED ☐ LG ☐ XL ☐ I will provide black shorts for my child ☐
I will provide socks ☐
Your child will be expected to participate in all practices. Repeated, unexcused absences may mean your child sits during the next game. You should make every effort to inform the coach before a missed practice.
The placement of your child to a particular team will be determined by the coaches and the commissioner, the placement will be based upon providing all players a level of play that will enhance their athletic ability and provide them with a safe playing environment
Please list all medical information that the CYA should be aware of. Include information about physical or mental conditions, allergies, hearing or vision problems and all medication taken (especially those children who would carry medicine with them). This information will be provided only to the child’s coaches. Insurance Type/Carrier: __________________________________________________ Insurance#: __________________________ Emergency Contact/Phone: _______________________________________________ Relation to child: ______________________
Please write down any IMPORTANT MEDICAL INFORMATION about your child:
____________________________________________________________________________________________________________ ***It is required by the CYA that at least one parent or guardian of each child participating in the program shall work, at a minimum, one “shift” in helping to run the Snack Shack. And one parent from each team will be designated (hopefully volunteer) as the “team parent” who will be responsible for coordinating the Snack Shack coverage for their team. Please note that the successful operation of the Snack Shack is extremely beneficial to the financial stability of the CYA in providing recreational programs for the youth of Chichester. *** Also, please check any other area in which you feel you would like to assist: Fundraising ☐
Team Parent ☐
Field Maintenance ☐
Coaching ☐
Other: ______________
Come and join the Chichester Youth Association, we are always glad to have new members join us to help plan/organize/carryout our activities to benefit the youth of our community.
If you require any additional information, you may contact: Soccer Commissioner Todd Monterio at [email protected] Please mail the registration form, please mail to the following address: Chichester Youth Association P.O. Box 394 Epsom, NH 03234
CODE OF CONDUCT FOR CHICHESTER COACHES, ATHLETES, AND PARENTS The youth of our community should have an opportunity to play sports in a safe, family-friendly environment, conducive to building good sportsmanship, respect for others and encouraging the development of self-esteem. In an attempt to provide this opportunity to our youth, the Chichester Youth Association has adopted a Code of Conduct which will be enforced on our fields during practice and game play, as well as on the playing grounds of our opponents by our home team players and their families or friends. I. II. III. IV. V. VI.
VII.
Respect for Property: Whether at practice, at a home or an away game, players for the Chichester Youth Association are representatives of the Town of Chichester, and shall treat all grounds, benches, fences and other structures with respect. Littering of any kind will not be tolerated. Use of Obscene or Profane Language or Gestures: Any player, parent, guest, coach or official at any sports event using obscene or profane language or gestures, or racial, ethnic or sexual slurs will not be tolerated, and may be banned from attending future youth events. Fighting: Initiating, threatening & engaging in fights or scuffles are strictly prohibited. Accident / Incident Reports: Any necessary first aid beyond a simple bandage requires a report to be filled out within 24 hours and returned to a board member of the CYA. Coaches must fill out and sign an incident report if a child is injured during any CYA activity. Respect for Team Obligation: Any lateness or absence from practice or games has a negative effect on the team. While it is understood that circumstances sometimes arise, Coaches must be notified of any anticipated lateness or absence. Return of Uniforms: Uniforms, unless otherwise stated, are property of the CYA and must be returned at the end of the season in a timely manner. A replacement fee may be charged for returnable items not returned. HAVE FUN: Most importantly, the time our children spend playing and learning sports on our fields and within our organization should be fun and safe. Interaction between players, parents and coaching staff should be of a positive nature, without the pressure or expectations to perform beyond their abilities as learning children. Adherence to the above policies will help to ensure that our children are receiving beneficial experiences that will be with them for a
lifetime.
As a parent/guardian of the above named player, I give approval for my child to participate in any and all Chichester Youth League activities. I assume all risks and hazards incidental to such participation and waive, release, absolve, indemnify and agree to hold harmless the Chichester Youth Association (CYA) and the organizers, sponsors, officers, directors, coaches, participants, Town of Chichester, School system and person transporting our child to and from activities from any claim arising out of injury to our child, whether the result of negligence or any other cause, except to the extent of and the amount of the Association or League Insurance. I understand that transportation to and from league games, practices and functions is the responsibility of the parent/guardian. I also agree to hold my child, myself, and my guests accountable to the code of conduct. PARENT/GUARDIAN SIGNATURE: ____________________________________________ DATE: __________________
