Transcript Slide 1

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This section for YS use only
PARENT INFORMATION *MUST PROVIDE AT LEAST TWO PHONE NUMBERS & EMAIL ADDRESS*
Sponsor’s Last Name:__________________________________Sponsor’s First Name:__________________________________Sponsor’s Rank/Title:____________
Home Phone:_______________________________Duty Phone:___________________________ Cell Phone:______________________________________________
Email:_____________________________________________________________Alt. Email:________________________________________________________________
Please provide at least
two phone numbers &
an email address.
Please Circle One: USMC / USN / ARMY / USAF / GS / NAF / DODDS / CONTRACTOR / RETIRED
Emergency Contact (other than parent listed above):
Please provide
requested information
or registration is
considered incomplete.
Last Name:________________________________________________ First Name:__________________________________________________Phone:_________________________________
I would like to : □ Head Coach □ Assistant Coach □ Team Parent (Volunteer Coaches: Coaching Application must be completed to be considered.)
Name of parent/guardian that will be volunteering to COACH: ________________________________________________________________________________
CHILD’S INFORMATION *MUST COMPLETE ALL SECTIONS, TO INCLUDE HEIGHT/WEIGHT/SKILL LEVEL*
Sport you are registering for: (Please check one) □ Baseball
□ Softball
□Cheerleading
□ Soccer
□Basketball
Player’s Last Name:_________________________________________________Player’s First Name:___________________________________________MI:________
Example:
Birth Date:
D
E
C
/
2
/
2
/
1
9
9
9
/
5ft
12
Age:
1in
Height :
115lbs
Weight:
Sex: □ Male
□Female
Please list any siblings also registered (name & age must be provided):
Name: _______________________________________ Age: ________
M/ F
Name: _______________________________________ Age: ________
M/ F
Name: _______________________________________ Age: ________
M/ F
Name: _______________________________________ Age: ________
M/ F
PRACTICE REQUESTS
*Requests for ages 5-8 will be considered but may not always be granted.*
Location that you are registering for:
___ CENTRAL (This area includes Foster/Kishaba/Futenma) ______ NORTH (This area includes Courtney/McT) ______ SOUTH (This area includes Kinser/Futenma)
*Specific camps in the Central, North or South locations can not be guaranteed. (e.g. McT can not be guaranteed over Camp Courtney).
Please note that if a practice
choice is not marked, SFYS
will assign a day/time for you.
DAYS: ____ MON. & WED. ____ TUES. & THURS. ____ ANY DAY
TIMES: ____ 1700-1800
____ 1800-1900 ____ 1900-2000
____ ANY TIME
If choosing “ANY DAY” but
would like to match this child to
older sibling’s team please
mark here: ______
** Spouses of deployed service members will receive 10% off the registration fee at the time of registration as well as hold priority for practice
time/location preference (if available). In order to qualify for this program, applicants must present their OIF/OEF deployed benefits card or a
copy of the deployment orders stating that their spouse will be absent for at least 30 days of the current playing season in support of OIF/OEF.
Without this documentation, we can not guarantee a request. WITHOUT DOCUMENTATION, PRIORITY WILL NOT BE GIVEN.
□Check here if participating in the Deployed Spouses Program (as stated above) and please indicate any practice requests here:_________________________________
MEDICIAL HISTORY
1.
2.
3.
4.
Does your child have any known medical conditions, ailments or abnormalities? Y / N
Is your child currently taking any medications?
Y / N
Has your child had any previous head, neck or back injuries?
Y / N
Does your child require an inhaler?
Y/ N
(If yes, please ensure that your child has it during games/practices and a
parent/guardian is present at all times to assist. Please do not give the inhaler
to a coach/official. )
**If you have answered “Yes” to any of the above questions,
please describe on the line provided below **Additional
information may be required.**
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
**Please attach a note if more space is required.**
MCCS GYM STAFF MUST COMPLETE THE BELOW SECTIONS AT THE TIME OF REGISTRATION ONLY
Child’s Birth date:
□ Verified on Age Roster □ If Not:
Day:_____________Month:_________________Year:_________________Age:_________
□ If claiming the Deployed Spouses Program, I have verified the applicant’s Deployed Spouses Benefit Program Card/Orders.
Employee’s Name(Print):________________________________________Date:______________Reg. Fee: ____________Receipt #:_________________________
YOUTH SPORTS COACHES ASSOCIATION
MCCS SOP XX-02, Subj: YOUTH SPORTS PROGRAM
PARENTS CODE OF ETHICS
I Hereby Pledge To Provide Positive Support, Care, And Encouragement For My Child Participating In Youth Sports By Following
This Code Of Ethics:
* I will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every game, practice and/or other youth sports
events.
* I will place the emotional and physical well being of my child ahead of any personal desire to win.
* I will insist that my child play in a safe and healthy environment.
* I will provide support for coaches and officials working with my child to provide a positive, enjoyable experience for all.
* I will demand a drug, alcohol, and tobacco-free environment for my child and agree to assist by refraining from their use at all youth sports events.
* I will remember that the game is for children and not for adults.
* I will do my very best to make youth sports fun for my child.
* I will ask my child to treat other players, coaches, fans, and officials with respect regardless of race, sex, creed, or ability.
* I will promise to help my child enjoy the youth sports experience within my personal constraints by assisting with coaching, being a respectful fan, providing
transportation or whatever I am capable of doing.
* I will require that my child's coach be trained in the responsibilities of being a youth sports coach and that the coach agrees to the youth sports Coaches' Code of
Ethics.
* I will read the NYSCA National Standards for Youth Sports and do everything in my power to assist all youth sports organizations to implement and enforce them.
* If an issue should develop on the field or court between coaches, referees, youth, and parents, this issue should be presented to an MCCS Youth Sports
representative in a calm and professional manner or prepare a clear and factual written statement to facilitate resolution and or initiate an investigation. If written, it
is to be submitted to Youth Sports within two working days. If resolution is not reached, military commands, inspectors, or other outside agencies will be notified.
*PLEASE READ AND INITIAL*
_____1. Special Requests: I understand that teams practice twice a week on the camp that they live on, or next closest camp available . I also
understand that unless participating in the Deployed Spouses Program, requests may be considered (for ages 5-8 only) but may not
always be granted. I understand that registering early during the registration period does not give my child priority for requests and will
not guarantee your team will have a coach.
_____2. “No switching teams” policy: I understand once SFYS has assigned an eligible player to a team, there will be no switching of teams or
trading of players with other teams. Special requests are granted for the placement of siblings (same team) if and only when they
are within the same age division. Coaches will select practice days and times. Upon registering, parents agree that they must plan
accordingly to accommodate practice times and location.
_____3. Advancing Divisions: I understand participants may not play in a lower age division that they belong (unless of a medical condition),
but may request to move up one age division providing there is room on the team and the move does not displace a child
belonging in that age division. However, the minimum playing time rule will be waived if a child moves up to the next higher division.
Once a child has been moved up to the next age division, he/she cannot be moved back down. In order to advance, the child
must be within one year of age of the requested division. (e.g. If a child is requesting to be moved to the Termite Division(ages 7-8),
he/she must be at least 6 years old to be considered.)
_____4. Volunteer Coaches: I understand registering my child during the registration period does not guarantee that your child’s team will have a
coach. Teams are built prior to coach placement therefore children are not specifically assigned to teams with or without a coach.
Parents will be contacted and one of the following may occur: (1) SFYS will attempt to place all children onto other teams if space is
available. (2) If not enough space available, children will be placed priority onto the waiting list in the order in which they registered.
(3) Refunds will be issued. At any time, a parent may request a refund as long as a uniform has not been issued/used. Requests for a
specific coach and/or team can not be guaranteed.
_____5. Image Release: In consideration for my child’s participation in MCCS SFYS, I agree that my likeness, or the likeness of my participating
child and family may be photographed or video taped and that such image may be published to promote or publicize the sports
program, for staff training or for MCCS Publications (to include online publications). I authorize MCCS to record, by video, film, audio
or any other means of recordation, my or my participating child’s image, likeness, voice and/or characteristics (the “images”) and
waive, release and discharge MCCS from any claim of right I may have now or in the future to those images.
_____6. Medical Care Authorization: I hereby authorize my child to receive emergency medical treatment whenever deemed necessary at any
U.S. Military Medical Facility or any other medical facility when an U.S. Medical Facility is not available.
_____7. Liability Statement: I hereby agree to release the U.S. and Japanese Governments, their officials, respective employees and agents,
including MCCS, its employees, officers and agents (collectively, the “Government”), as well as any and all Youth Sports staff, officials,
sponsors, volunteers and participants from any liability and from any claims whatsoever for loss, personal injury or property damage
arising from or related to my child’s participation in the SFYS program. Furthermore, I agree to hold harmless and indemnify the
Government from any claims, costs or expenses which may arise out of my child’s participation in the SFYS program.
By signing below, I verify that I have read, fully understand/comply and declare the information contained herein is correct, true and complete.
Without a signature/initials, registration will automatically be rejected by the Semper Fit Youth Sports Office.
 Parent’s Printed Name:_________________________________________  Parent’s Signature:_________________________________________Date:_________________