margate basketball league - City of Margate
Youth Basketball Registration Form PLEASE PRINT CLEARLY
Participant’s First Name ______________________________ Last Name _________________________ Date of Birth: _______/_______/_______
Age: _______
Gender: ( ) Male ( ) Female
Street Address _______________________________ City ________________________ Zip _________ Home Phone: _______________________________ Cell Phone: ________________________________ E-mail Address: _______________________________________________________________________ Parent/Legal Guardian Name: ______________________________/______________________________ Print Signature *********************************************************************************************
Emergency Contacts 1. Name__________________________________
2. Name__________________________________
Address________________________________
Address________________________________
Phone_________________________________
Phone_________________________________
*********************************************************************************************
Medical Release I understand medications cannot be given to any child or anyone employed by the City of Margate. In the event of an emergency, can we transport your child via ambulance to an appropriate medical facility when unable to make immediate contact with a parent/guardian? YES / NO *********************************************************************************************
Jersey Size YS
YM
YL
AS
AM
AL
AXL
AXXL
Parent Initial: ____________
*********************************************************************************************
* A $25 Cancellation Fee applies to all refund requests. Refund requests that occur after teams have been drafted will be assessed the $25 Cancellation Fee + Jersey Cost. FOR OFFICE USE ONLY
Payment type:
[ ] Cash
Fee Paid: $__________
[ ] Money Order # _______________ RCPT #: ___________
Copy or Child’s Birth Certificate verified. Code of Ethics/ Concussion Policy signed. Jersey Size verified and initialed by Parent. Approved as to form Douglas R. Gonzales, City Attorney 2016.8
Date: __________ Yes Yes Yes
No No No
[ ] Check # _____________ Staff Initials: _____________
Parent and Player Code of Ethics The Margate Parks and Recreation Department recognizes that the lessons learned during youth basketball extend far beyond the court. So in order to create a positive, encouraging environment for our players, the Margate Youth Basketball League requests that each parent and player read, sign and return the Parents & Players Code of Ethics.
PARENTS:
I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every game, practice, or other youth sports event. I will place the emotional and physical well-being of my child ahead of a personal desire to win. I will insist that my child play in a safe and healthy environment. I will support coaches & officials working with my child to encourage a positive and enjoyable experience for all. I will bring my child to all practices; if I miss a practice, I will notify the coach with a reason for the child’s absence. I will demand a sports environment for my child that is free of drugs, tobacco, and alcohol, and will refrain from their use at all youth sports events. I will remember that the game is for youth – not for adult; I will do my best to make youth sports fun for my child. I will ask my child to treat players, coaches, fans, and officials with respect regardless of race, sex, creed or ability. I promise to help my child enjoy the youth sports experience by doing whatever I can, such as being a respectful fan, assisting when needed, or providing transportation. I will require that my child's coach be trained in the responsibilities of being a youth sports coach and that the coach upholds the Coaches' Code of Ethics.
PLAYERS:
I will encourage good sportsmanship from fellow players, coaches, officials and parents at every game and practice by demonstrating good sportsmanship. I will expect to receive a fair and equal amount of playing time. I will do my very best to listen and learn from my coaches; I will not use profanity, nor will I initiate a fight. I will treat my coaches, other players, officials and fans with respect regardless of race, sex, creed or abilities, and I will expect to be treated accordingly. I deserve to have fun during my sports experience and will alert parents or coaches if it stops being fun! I deserve to play in an environment that is free of drugs, tobacco, and alcohol. I will encourage my parents to be involved with my team in some way. *********************************************************************************************
Code of Ethics Violation: Corrective Action Policy The following could occur when in violation of the above policies: 1. Verbal Warning: a verbal warning from park staff that will be documented and filed 2. Written Warning: written reprimand warning of possible suspension should a next offense occur 3. Game Suspension: verbal/written notification from staff of suspension for the next scheduled game 4. Season Suspension/League Ban: formal letter with notification of a season suspension or league ban I have read and understand both the Parents & Players Code of Conduct and the Corrective Action Policy. I hereby sign it voluntarily and with full knowledge of its significance: ___________________________________/___________________________________ Player’s Name Signature
____________ Date
__________________________________/___________________________________ Parent/Legal Guardian Name Signature
_____________ Date
Approved as to form Douglas R. Gonzales, City Attorney 2016.56
Head Injuries & Concussion Policy It shall be the policy of the City of Margate Youth Basketball League that all coaches, players, parents/guardians, administrators and park staff be familiar with the signs and symptoms of head injuries and concussions. Be prepared to take the appropriate actions outlined below. The above listed is for informational purposes, and you will not be trained to “diagnose” a concussion. What we are emphasizing is that we all use our best judgment in observing signs, symptoms, or behaviors associated with head injuries and concussions. The diagnosis of a concussion is the job of a qualified health care provider. Sign’s & Symptoms: Nausea Restless/Irritable Memory Loss Difficulty Concentrating
Vomiting Dizziness Confusion Seeing Stars
Headache Double or Blurred Vision Ringing of the ears Other unusual behaviors
Policy: 1. 2. 3. 4.
Remove player from practice or game. Notify parent/guardian and appropriate park staff. Call an ambulance if necessary (parental approval may be necessary). Any player suspected of having a concussion should have a qualified health care provider evaluate them as soon as practicable. 5. Before allowing a player to resume participation in any practices or games, the parent/guardian of the player must obtain and return to a park staff member a statement from a qualified health care provider authorizing the player to resume play. 6. “When in doubt, sit them out!” ******************************************************************************* Please sign to confirm that you have read and understand the Head Injuries & Concussion Policy:
_________________________________/_________________________________ Player’s Name Signature
_______________ Date
_________________________________/_________________________________ Parent/Legal Guardian Name Signature
_______________ Date
Approved as to form Douglas R. Gonzales, City Attorney 2016.57
Participant’s First Name ______________________________ Last Name _________________________ Date of Birth: _______/_______/_______
Age: _______
Gender: ( ) Male ( ) Female
Street Address _______________________________ City ________________________ Zip _________ Home Phone: _______________________________ Cell Phone: ________________________________ E-mail Address: _______________________________________________________________________ Parent/Legal Guardian Name: ______________________________/______________________________ Print Signature *********************************************************************************************
Emergency Contacts 1. Name__________________________________
2. Name__________________________________
Address________________________________
Address________________________________
Phone_________________________________
Phone_________________________________
*********************************************************************************************
Medical Release I understand medications cannot be given to any child or anyone employed by the City of Margate. In the event of an emergency, can we transport your child via ambulance to an appropriate medical facility when unable to make immediate contact with a parent/guardian? YES / NO *********************************************************************************************
Jersey Size YS
YM
YL
AS
AM
AL
AXL
AXXL
Parent Initial: ____________
*********************************************************************************************
* A $25 Cancellation Fee applies to all refund requests. Refund requests that occur after teams have been drafted will be assessed the $25 Cancellation Fee + Jersey Cost. FOR OFFICE USE ONLY
Payment type:
[ ] Cash
Fee Paid: $__________
[ ] Money Order # _______________ RCPT #: ___________
Copy or Child’s Birth Certificate verified. Code of Ethics/ Concussion Policy signed. Jersey Size verified and initialed by Parent. Approved as to form Douglas R. Gonzales, City Attorney 2016.8
Date: __________ Yes Yes Yes
No No No
[ ] Check # _____________ Staff Initials: _____________
Parent and Player Code of Ethics The Margate Parks and Recreation Department recognizes that the lessons learned during youth basketball extend far beyond the court. So in order to create a positive, encouraging environment for our players, the Margate Youth Basketball League requests that each parent and player read, sign and return the Parents & Players Code of Ethics.
PARENTS:
I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every game, practice, or other youth sports event. I will place the emotional and physical well-being of my child ahead of a personal desire to win. I will insist that my child play in a safe and healthy environment. I will support coaches & officials working with my child to encourage a positive and enjoyable experience for all. I will bring my child to all practices; if I miss a practice, I will notify the coach with a reason for the child’s absence. I will demand a sports environment for my child that is free of drugs, tobacco, and alcohol, and will refrain from their use at all youth sports events. I will remember that the game is for youth – not for adult; I will do my best to make youth sports fun for my child. I will ask my child to treat players, coaches, fans, and officials with respect regardless of race, sex, creed or ability. I promise to help my child enjoy the youth sports experience by doing whatever I can, such as being a respectful fan, assisting when needed, or providing transportation. I will require that my child's coach be trained in the responsibilities of being a youth sports coach and that the coach upholds the Coaches' Code of Ethics.
PLAYERS:
I will encourage good sportsmanship from fellow players, coaches, officials and parents at every game and practice by demonstrating good sportsmanship. I will expect to receive a fair and equal amount of playing time. I will do my very best to listen and learn from my coaches; I will not use profanity, nor will I initiate a fight. I will treat my coaches, other players, officials and fans with respect regardless of race, sex, creed or abilities, and I will expect to be treated accordingly. I deserve to have fun during my sports experience and will alert parents or coaches if it stops being fun! I deserve to play in an environment that is free of drugs, tobacco, and alcohol. I will encourage my parents to be involved with my team in some way. *********************************************************************************************
Code of Ethics Violation: Corrective Action Policy The following could occur when in violation of the above policies: 1. Verbal Warning: a verbal warning from park staff that will be documented and filed 2. Written Warning: written reprimand warning of possible suspension should a next offense occur 3. Game Suspension: verbal/written notification from staff of suspension for the next scheduled game 4. Season Suspension/League Ban: formal letter with notification of a season suspension or league ban I have read and understand both the Parents & Players Code of Conduct and the Corrective Action Policy. I hereby sign it voluntarily and with full knowledge of its significance: ___________________________________/___________________________________ Player’s Name Signature
____________ Date
__________________________________/___________________________________ Parent/Legal Guardian Name Signature
_____________ Date
Approved as to form Douglas R. Gonzales, City Attorney 2016.56
Head Injuries & Concussion Policy It shall be the policy of the City of Margate Youth Basketball League that all coaches, players, parents/guardians, administrators and park staff be familiar with the signs and symptoms of head injuries and concussions. Be prepared to take the appropriate actions outlined below. The above listed is for informational purposes, and you will not be trained to “diagnose” a concussion. What we are emphasizing is that we all use our best judgment in observing signs, symptoms, or behaviors associated with head injuries and concussions. The diagnosis of a concussion is the job of a qualified health care provider. Sign’s & Symptoms: Nausea Restless/Irritable Memory Loss Difficulty Concentrating
Vomiting Dizziness Confusion Seeing Stars
Headache Double or Blurred Vision Ringing of the ears Other unusual behaviors
Policy: 1. 2. 3. 4.
Remove player from practice or game. Notify parent/guardian and appropriate park staff. Call an ambulance if necessary (parental approval may be necessary). Any player suspected of having a concussion should have a qualified health care provider evaluate them as soon as practicable. 5. Before allowing a player to resume participation in any practices or games, the parent/guardian of the player must obtain and return to a park staff member a statement from a qualified health care provider authorizing the player to resume play. 6. “When in doubt, sit them out!” ******************************************************************************* Please sign to confirm that you have read and understand the Head Injuries & Concussion Policy:
_________________________________/_________________________________ Player’s Name Signature
_______________ Date
_________________________________/_________________________________ Parent/Legal Guardian Name Signature
_______________ Date
Approved as to form Douglas R. Gonzales, City Attorney 2016.57
