basketball

SEASON

jan. 6 – feb. 22

Register online:

Metroparkstacoma.org/

Youth–AfterSchoolSportsRegister onlineacoma.org/

o

all

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Soccer, Golf, Basketball, Flag Football,

Volleyball & Baseball

Soccer, Golf, Basketball, Flag Football,

Volleyball & Baseball

ELEMENTARY

SPORTs PROGRAMELEMENTARY

SPORTs PROGRAM

Physical Activity

Physical Activity

Teamwork

egister onlinoma.o

School Pride School Pride

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Registration will end

December 16, 2019

MPT Program SitesArlington

Birney

Blix

Boze

Browns Point

Crescent Heights

Edison Elementary

Fawcett

Fern Hill

Franklin

Jefferson

Larchmont

Mary Lyon

Mann

McCarver

NE Tacoma

Pt. Defiance

Reed

Sheridan

Sherman

Skyline

Stafford

Wainwright

Washington

Whitman

Whittier

Other:_______________

YMCA Program SitesBryant

Delong

Geiger

Grant

Lister

Lowell

Roosevelt

Boys & Girls Club Program SitesDowning

Manitou

Stanley

Parent Information (attached) Concussion and Sudden Cardiac Awareness Informed Consent

TPS Student ID#

Participant’s Name

Date of Birth Male Female

Health:Does your child have any health concerns or take

any medications?

YES NO (Circle one)

List:

Shirt Size(Unisex Sizes)

Youth Sizes: Small (6-8) Medium (10-12) Large (14-16)

Adult Sizes: Small, Medium, Large, Extra-Large, XX-Large

Grade (2017-2018)Circle One K/1 2/3 4/5

BASKETBALL SEASON (SELECT YOUR SCHOOL):

ELEMENTARY SPORTS PROGRAM - INDIVIDUAL REGISTRATION FORM Cost: $68 per sport (Scholarships available)

IMPORTANT: Three forms are required. Go to MetroParksTacoma.org/Youth-AfterSchoolSports to access these forms:

BasketballOPEN REG

Flag FootballWinter/Spring

VolleyballWinter/Spring

BaseballSpring

GolfSpring

SoccerFall

Updated 6/4/2018

Register online:MetroParksTacoma.org/Youth-AfterSchoolSports

Or bring this form to any Metro Parks Tacoma

Community Center or headquarters: 4702 S. 19th St.

Parent Information

Parent/Guardian:

DOB E-Mail

Address: City/State: Zip Code:

Home Phone: Cell Phone: Work Phone:

Parent Pledge ▪ I will remember that children participate to have fun and that the game is for youth, not adults. ▪ I will inform the coach of any disability or ailmentthat may affect the safety of my child or the safety of others. ▪ I will learn the rules of the game and the league policies.

▪ I (and my guests) will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy, and by demonstratingpositive support for all players, coaches, officials and spectators at every game, practice or other sporting event. ▪ I (and my guests) will not engage inany kind of unsportsmanlike conduct with any official, coach, player, or parent such as booing and taunting; refusing to shake hands; or usingprofane language or gestures. ▪ I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence.▪ I willdemand that my child treat other players, coaches, officials and spectators with respect regardless of race, creed, color, sex or ability. ▪ I will teach mychild that doing one's best is more important than winning in an attempt to ensure that my child will never feel defeated by the outcome of a game orhis/her performance. ▪ I will praise my child for competing fairly and trying hard, and make my child feel like a winner every time. ▪ I will emphasizeskill development and practices and how they benefit my child over winning. I will also deemphasize games and competition in the lower age groups.▪ 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. ▪ I will respect theofficials and their authority during games and will never question, discuss, or confront coaches at the game field, and will take time to speak withcoaches at an agreed upon time and place. ▪ I will demand a sports environment for my child that is free from drugs, tobacco, and alcohol and I willrefrain from their use at all sports events. ▪ I will refrain from coaching my child or other players during games and practices, unless I am one of theofficial 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 notlimited to the following:

◦Verbal warning by official, head coach, and/or head of league organization ◦ Written warning ◦ Parental game suspension with writtendocumentation of incident kept on file by organizations involved ◦ Game forfeit through the official or coach ◦ Parental season suspension◦ Removal of my child from the program.

Release of liability I waive all rights and release all claims that might be had against Metro Parks Tacoma/BGCSPS/YMCA/Tacoma Public Schools, its hired or contracted instructors, and their employees and agents, for any and all injuries or losses which may be suffered because of my participation or my child’s or children’s participation in the above activity offered by the Metro Parks Tacoma/BGCSPS/YMCA/Tacoma Public Schools, in consideration of permission of the Metro Parks Tacoma/BGCSPS/YMCA/Tacoma Public Schools to participate in the activity. I consent to my child’s participation in the activity/program of Metro Parks Tacoma/BGCSPS/YMCA/Tacoma Public Schools and authorize them and their employees or agents to provide emergency medical treatment for my child on my behalf. To the best of my knowledge, my child has no physical or other conditions that would interfere with his/her participation. I give my permission to have my photo or the photo of my child or children, taken during the activity used for publicity purposes by the Metro Parks Tacoma/BGCSPS/YMCA/Tacoma Public Schools. I consent to the use of my name, likeness and voice of those or those of my children, without monetary compensation, in connections with the Park District “Park Guide” TV program or other video presentations, and with the program publicity, and expressly release Tacoma Municipal Television agents, City of Tacoma, its agents, and Metro Parks Tacoma/BGCSPS/YMCA/Tacoma Public Schools and its agents from any and all claims for damages for libel, slander, invasion of privacy or any other claim arising out of broadcast, exhibition, promotion, or presentation of this program, Tacoma Municipal Television is a division of the General Services Department of the City of Tacoma.

Signature: Parent / Legal Guardian / Participant (18 years or older) Date

Does parent have interest in coaching?

YES NO (Circle one)

OFFICE USE ONLY

Amount Paid _____________

Receipt # ________________

Date Paid ________________

INFORMED CONSENT FORM

_________________________________ (Insert sport/activity to participate in)

Student Name: Birth Date:

School: Grade:

We accept and understand that the sport of (Sport/Activity) involves certain inherent risks, dangers and hazards that may cause serious personal injury, including death, severe paralysis or brain injury necessitating long term care and significantly impairing enjoyment of life or life activities. We accept and understand that the above-described injuries and other injuries, including but not limited to: concussions; serious neck and spinal injuries potentially resulting in complete or partial paralysis; brain damage; blindness; serious injury to all internal organs; serious injury to all bones, joints, ligaments, muscles and tendons; contusions; dislocations; sprains; strains; and fractures, may occur as a result of participating in this sport. We accept and understand that certain activities such as batting, fielding and sliding carry with them a greater inherent risk of injury.

We understand that the inherent risks of this sport cannot be eliminated without jeopardizing the essential qualities of the sport. We have reviewed all of these risks and we understand and appreciate them and still desire to participate in the activity. (Participant Initial)________ (Parent Initial)________

We certify that (Student Name) __________________________________has no medical or physical conditions which could interfere with or compromise his/her safety in participating in this activity. (Participant Initial)________ (Parent Initial)________

I authorize qualified emergency medical professionals to examine, and in the event of an injury or serious illness, to administer emergency medical care to the above-named student. (Parent Initial)________

In the event it becomes necessary for program staff to obtain emergency medical care for the above-named student, we understand that neither the staff member nor the agency assumes financial liability for the expenses incurred because of the accident, injury, illness and/or unforeseen circumstances. (Participant Initial)________ (Parent Initial)________

I certify that my household has sufficient medical insurance to facilitate any necessary medical care or resultant care for any injury that may be sustained by the above-named participant. (Parent Initial)________

HAVING READ AND INITIALED THE STATEMENTS ABOVE, I ACKNOWLEDGE THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS VOLUNTARY ELEMENTARY SCHOOL SPORTS PROGRAM. BY SIGNING BELOW, I CERTIFY THAT I HAVE READ THE ABOVE, UNDERSTAND ITS CONTENT AND WISH TO PARTICIPATE.

Participant name (please print) Student signature Date

HAVING READ AND INITIALED THE STATEMENTS ABOVE, I ACKNOWLEDGE THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS VOLUNTARY ELEMENTARY SCHOOL SPORTS PROGRAM. BY SIGNING BELOW, I CERTIFY THAT I HAVE READ THE ABOVE, UNDERSTAND ITS CONTENT AND GIVE MY PERMISSION FOR MY STUDENT TO PARTICIPATE.

Parent/Guardian name (please print) Parent/Guardian signature Date

Student/Parent Concussion and Sudden Cardiac Arrest Awareness Form

Tacoma Public School, Metro Parks Tacoma, YMCA and Boys and Girls Clubs of America believe participation in athletics improves physical fitness, coordination, self-discipline, and gives students valuable opportunities to learn important social and life skills.

With this in mind it is important that we do as much as possible to create and maintain an enjoyable and safe environment. As a parent/guardian or student you play a vital role in protecting participants and helping them get the best from sport.

Player and parental education in this area is crucial which is the reason for the Concussion Management and Sudden Cardiac Arrest Awareness pamphlet you have been directed to read. Refer to it regularly.

This form must be signed annually by the parent/guardian and student prior to participation in the Elementary School Sports Program. If you have questions regarding any of the information provided in the pamphlet, please contact the program administrator at your specific elementary school.

I HAVE RECEIVED, READ AND UNDERSTAND THE INFORMATION PRESENTED IN THE CONCUSSION RECOGNITION AND SUDDEN CARDIAC ARREST AWARENESS PAMPHLETS.

____________________________________ _______________________________ ________ Participant Name (Printed) Participant Name (Signed) Date

____________________________________ _______________________________ ________ Parent Name (Printed) Parent Name (Signed) Date

CODE OF CONDUCT FOR SPECTATORS

Coaches are responsible for the conduct of their spectators and are expected to make them aware of the Codes applicable to them.

Spectators:

1. I will not engage in unsportsmanlike conduct with any coach, parent, participant, official or anyother attendee.

2. I will not encourage my child, or any other person, to engage in unsportsmanlike conduct withany coach, parent, player, participants, official or any other attendee.

3. I will not engage in any behavior which would endanger the health, safety or well-being of anycoach, parent, player, participant, official or any other attendee.

4. I will not encourage my child, or any other person, to engage in any behavior which wouldendanger the health, safety or well-being of any coach, parent, player, participant, official or anyother attendee.

5. I will not engage in the use of profanity.6. I will not encourage my child, or any other person to engage in the use of profanity.7. I will treat any coach, parent, player, participant, official or any other attendee with respect at

all times regardless of sex, creed, color, national origin, sex or ability.8. I will not engage in verbal or physical threats or abuse aimed at any coach, parent, player,

participant, official or any other attendee.9. I will not initiate nor encourage my child to initiate a fight or scuffle with any coach, parent,

player, participant, official or any other attendee.10. I will be responsible for the behavior of all those attending the program or sports event on my

child’s behalf.11. I will not shout instructions, coach or direct players on the field from the stands nor the

sidelines.12. I will not address the officials from the sidelines in any manner.

Parents, Guardians or anyone attending a program may be asked to exit the facility any not return if any above conducts are violated. This is at the discretion of the field supervisor or officials onsite.

Signature:_______________________________ Date:_____________________

Name:__________________________________ Phone:___________________