LRGS Player Application 2017
PLAYER APPLICATION
For League Use Only:
Make checks payable to: LRGS Mail to: PO Box 362, Laconia, NH 03247
League Age:
Fees: 6U-$35, 8U-$45, 10U-$55, 12U-$65, Seniors-$75
Division:
REGISTRANT INFORMATION (PLEASE PRINT):
Fee: Cash or Check #
Player’s Last Name
First Name
Middle Initial
Date of Birth
Best Contact Phone #
Email Address
.
Family Discount: Y N 1.
Physical Address (do not list PO Box)
City
T-Shirt Size (specify youth or adult)
State
Zip Code
Birth Certificate Proof of Residency
Returning LRGS Player?
Primary Parent/Guardian Info (PLEASE PRINT) First Name
2. Required Documents:
Last Name
Secondary Parent/Guardian Info First Name
Email
Email
Phone #
Phone #
Last Name
Who does the player live with? Mother / Father / Both / Other MEDICAL RELEASE/EMERGENCY CONTACT: In case of an emergency, please notify
Phone #:
(other than parent/guardian)
Family Physician:
Phone:
Health Insurance Carrier:
Policy #:
Please list any allergies and/or medical problems, including those requiring maintenance medications. (i.e. diabetes, asthma, etc). Medical Diagnosis
Medication
Dosage
Is the player’s Tetanus booster up-to-date?
Frequency of Dosage
YES
NO
The purpose of the information listed above is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment should your child become injured. As the parent/guardian, I understand that participation in any sport, including softball, may result in serious injuries and protective equipment does not prevent all injuries. In case of an emergency, I hereby authorize the above named player to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician). I also agree to waive, release, absolve, indemnify and hold harmless Lakes Region Girls Softball, the board of directors, sponsors, volunteers and participants for any claim arising out of any injury to my child whether the result of negligence or any other cause. Parent/Guardian Signature: Parent/Guardian Printed Name:
Date:
/
/
.
LRGS PLAYER APPLICATION – 2017
Photo Release: I hereby consent to LRGS’ use of my child’s photograph and likeness in its publications and advertising materials, including on its website/social media pages. I release LRGS, its directors, officers, supervisors, coaches and volunteers from any expectation of confidentiality or privacy for the minor child in relation to LRGS’ operations, advertising, and website materials. I agree _______ I do not agree ______ Fundraising: LRGS requires each registered player to fundraise a minimum of $50. I understand I can choose to opt out of this obligation by initialing below and paying a $50 fundraising fee. Payment of this fee is due at time of registration. I wish to opt out of fundraising ________ Refunds: Once a player is registered, should they decide not to play for LRGS, a written request must be submitted to the league Registrar no later than April 1st in order to receive a full refund. No refunds will be issued once teams are formed. I understand LRGS’ refund policy Parental Code of Conduct: Lakes Region Girls Softball has implemented the following Parental Code of Conduct. Please read carefully prior to your child participating in any LRGS activity. I will: Remember that children participate to have fun and that the game is for the youth, not adults. Ask my child to treat other players, coaches, fans and officials with respect. Learn the rules of the game and the policies of the league. Praise my child for competing fairly and trying hard. Respect the officials and their authority during games and will never question, discuss, or confront coaches or umpires at the game field, and will take time to speak with coaches at an agreed upon time and place. Demand a sports environment for my child that is free from drugs, tobacco, and alcohol and I will refrain from their use at all LRGS events. Refrain from coaching my child and/or other players during games and practices, unless I am one of the official team coaches Help my child enjoy the youth sports experience by doing whatever I can, such as being a respectful fan, assisting with coaching, or providing transportation. Furthermore: I understand LRGS needs volunteers in order to provide a successful softball program for my child. During this season, I may be asked to assist the team in some capacity (i.e. team parent, field prep, concessions, etc.). I (and my guests) will be positive role models 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 LRGS event. I (and my guests) will not engage in any kind of unsportsmanlike conduct with officials, coaches, players, or parents such as booing and taunting; refusing to shake hands; or using profane language or gestures, etc. I will bring any questions/concerns/complaints to the appropriate league official(s) for resolution rather than talk negatively about the organization to others. I understand if I fail to follow this code of conduct, I could face disciplinary action as defined in the LRGS ByLaws. By signing below, I attest that I have read and understood Lakes Region Girls Softball’s policies on the use of photographs, fundraising and refunds. My signature also confirms I have read and understood the parental code of conduct. I do hereby give permission for my child to participate in any and all LRGS League activities. Parent/Guardian Signature:
Date:
/
/
ARTICLE XVII: DISCIPLINARY ACTION st A.) 1 Offense: A warning will be issued by the LRGS Officer on Duty. The offender is to cease inappropriate behavior immediately. If not, refer to protocol for second offense. nd B.) 2 Offense: Removal from the field. The LRGS Officer on Duty has the authority to ask the offender to leave the premises. If the offender refuses to leave, LRGS has the right to contact local law enforcement. rd C.) 3 Offense: Suspension from future events. Depending on the severity of the offense, the LRGS Board will determine the length of suspension.
LRGS PLAYER APPLICATION – 2017
For League Use Only:
Make checks payable to: LRGS Mail to: PO Box 362, Laconia, NH 03247
League Age:
Fees: 6U-$35, 8U-$45, 10U-$55, 12U-$65, Seniors-$75
Division:
REGISTRANT INFORMATION (PLEASE PRINT):
Fee: Cash or Check #
Player’s Last Name
First Name
Middle Initial
Date of Birth
Best Contact Phone #
Email Address
.
Family Discount: Y N 1.
Physical Address (do not list PO Box)
City
T-Shirt Size (specify youth or adult)
State
Zip Code
Birth Certificate Proof of Residency
Returning LRGS Player?
Primary Parent/Guardian Info (PLEASE PRINT) First Name
2. Required Documents:
Last Name
Secondary Parent/Guardian Info First Name
Phone #
Phone #
Last Name
Who does the player live with? Mother / Father / Both / Other MEDICAL RELEASE/EMERGENCY CONTACT: In case of an emergency, please notify
Phone #:
(other than parent/guardian)
Family Physician:
Phone:
Health Insurance Carrier:
Policy #:
Please list any allergies and/or medical problems, including those requiring maintenance medications. (i.e. diabetes, asthma, etc). Medical Diagnosis
Medication
Dosage
Is the player’s Tetanus booster up-to-date?
Frequency of Dosage
YES
NO
The purpose of the information listed above is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment should your child become injured. As the parent/guardian, I understand that participation in any sport, including softball, may result in serious injuries and protective equipment does not prevent all injuries. In case of an emergency, I hereby authorize the above named player to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician). I also agree to waive, release, absolve, indemnify and hold harmless Lakes Region Girls Softball, the board of directors, sponsors, volunteers and participants for any claim arising out of any injury to my child whether the result of negligence or any other cause. Parent/Guardian Signature: Parent/Guardian Printed Name:
Date:
/
/
.
LRGS PLAYER APPLICATION – 2017
Photo Release: I hereby consent to LRGS’ use of my child’s photograph and likeness in its publications and advertising materials, including on its website/social media pages. I release LRGS, its directors, officers, supervisors, coaches and volunteers from any expectation of confidentiality or privacy for the minor child in relation to LRGS’ operations, advertising, and website materials. I agree _______ I do not agree ______ Fundraising: LRGS requires each registered player to fundraise a minimum of $50. I understand I can choose to opt out of this obligation by initialing below and paying a $50 fundraising fee. Payment of this fee is due at time of registration. I wish to opt out of fundraising ________ Refunds: Once a player is registered, should they decide not to play for LRGS, a written request must be submitted to the league Registrar no later than April 1st in order to receive a full refund. No refunds will be issued once teams are formed. I understand LRGS’ refund policy Parental Code of Conduct: Lakes Region Girls Softball has implemented the following Parental Code of Conduct. Please read carefully prior to your child participating in any LRGS activity. I will: Remember that children participate to have fun and that the game is for the youth, not adults. Ask my child to treat other players, coaches, fans and officials with respect. Learn the rules of the game and the policies of the league. Praise my child for competing fairly and trying hard. Respect the officials and their authority during games and will never question, discuss, or confront coaches or umpires at the game field, and will take time to speak with coaches at an agreed upon time and place. Demand a sports environment for my child that is free from drugs, tobacco, and alcohol and I will refrain from their use at all LRGS events. Refrain from coaching my child and/or other players during games and practices, unless I am one of the official team coaches Help my child enjoy the youth sports experience by doing whatever I can, such as being a respectful fan, assisting with coaching, or providing transportation. Furthermore: I understand LRGS needs volunteers in order to provide a successful softball program for my child. During this season, I may be asked to assist the team in some capacity (i.e. team parent, field prep, concessions, etc.). I (and my guests) will be positive role models 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 LRGS event. I (and my guests) will not engage in any kind of unsportsmanlike conduct with officials, coaches, players, or parents such as booing and taunting; refusing to shake hands; or using profane language or gestures, etc. I will bring any questions/concerns/complaints to the appropriate league official(s) for resolution rather than talk negatively about the organization to others. I understand if I fail to follow this code of conduct, I could face disciplinary action as defined in the LRGS ByLaws. By signing below, I attest that I have read and understood Lakes Region Girls Softball’s policies on the use of photographs, fundraising and refunds. My signature also confirms I have read and understood the parental code of conduct. I do hereby give permission for my child to participate in any and all LRGS League activities. Parent/Guardian Signature:
Date:
/
/
ARTICLE XVII: DISCIPLINARY ACTION st A.) 1 Offense: A warning will be issued by the LRGS Officer on Duty. The offender is to cease inappropriate behavior immediately. If not, refer to protocol for second offense. nd B.) 2 Offense: Removal from the field. The LRGS Officer on Duty has the authority to ask the offender to leave the premises. If the offender refuses to leave, LRGS has the right to contact local law enforcement. rd C.) 3 Offense: Suspension from future events. Depending on the severity of the offense, the LRGS Board will determine the length of suspension.
LRGS PLAYER APPLICATION – 2017
