Transcript
City of Los Angeles • Department of Recreation and Parks
CHEVIOT HILLS RECREATION CENTER
SPORTS REGISTRATION FORM (AGES 9-17) YEAR: 2017
SEASON:
Fall Spring
Winter Summer
CO-REC GIRLS
SPORT:
DIVISION:
PLAYER INFORMATION:
CHECK IF YOU HAVE A SIBLING PLAYING AT CHEVIOT HILLS THIS SEASON
First Name:
Last Name:
Birthdate:
Age:
School:
Grade in Fall 2017:
PARENT/GUARDIAN INFORMATION: First Name:
Last Name:
Address: City:
Zipcode:
Best Contact #:
2nd Best Contact #:
Email: Emergency Contact Name:
Best Contact #:
PRACTICE REQUEST: Check one (1) day that your child isn’t available to practice. Practice is 1 day during the week for an hour MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
PLEASE INITIAL EACH POLICY BELOW: REFUND POLICY: A non-refundable 15% administrative fee will be assessed by the City of Los Angeles Department of Recreation and Parks for any patron granted a refund, change, or transfer before the player evaluations. No Refunds will be issued after the Friday before the first game of the season unless the program is cancelled by the Recreation Center. PLAYER EVALUATION: By registering, you agree to attend one of the player evaluations listed on the season flyer. I understand that if my child does not show up, I will be subject to the refund policy listed above. PARENT CONSENT: By registering, you understand that you are giving your authorization to participate in the Cheviot Hills Recreation Center programs and all activities therein. You further agree to relieve the City of Los Angeles Department of Recreation and Parks, its officer, agents, and employees from any liability for injury to you or your child(ren) resulting from and/or in connection with the activities in this program. You understand that the Recreation Center carries no insurance. You do hereby authorize the City of Los Angeles to act as agent for you and your child(ren): to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, treatment/hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medicine Practice Act and on the medical staff of a licensed hospital; whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. This authorization is given in advance of any specific consent. PHOTO RELEASE: By participating in our programs, patrons agree to allow the City of Los Angeles Department of Recreation and Parks and the Cheviot Hills Recreation Center to use photographs, video tapes, and testimonials of participants for use in publicity materials free of any fee or usage charge. I have read, understand, and agree to abide by the above mentioned policies and practices. SIGNATURE OF PARENT/GUARDIAN:
DATE:
City of Los Angeles • Department of Recreation and Parks
CHEVIOT HILLS RECREATION CENTER
PARENT/GUARDIAN’S CODE OF CONDUCT: I HEREBY PLEDGE TO LIVE UP TO MY RESPONSIBILITIES AS A PARENT/GUARDIAN OF A CHILD PARTICIPATING IN THE DEPARTMENT OF RECREATION AND PARKS SPORTS PROGRAM BY FOLLOWING THE PARENT/GUARDIAN’S CODE OF CONDUCT. 1. I WILL place the emotional and physical well-being of the children above any personal desire to win. I will help my child understand the valuable lessons sports can teach. 2. I WILL be a role model of good sportsmanship and character. I will help my child meet his/her responsibilities to the coach and the team. 3. I WILL do my best to make sure that the game is fun for all participants. I will remember not to take the game or myself too seriously. 4. I WILL lead by example in demonstrating fair play and sportsmanship to all participants. I will treat participants, coaches, recreation administrators, and the public with respect. 5. I WILL help maintain a sports environment for all participants that is free of drugs, tobacco, and alcohol. I will refrain from their use at all youth sports events. 6. I WILL make only positive and encouraging comments to players on both teams. I will not interfere or coach from the stands. 7. I WILL remember that I am a youth sports parent and that the game is for children and not adults. Accordingly, I will encourage my child to play sports by providing a supportive atmosphere, but not pressure them. 8. I WILL discuss the significance of this code with my family members. I understand the penalties for not adhering to this Code of Conduct range from a verbal warning to expulsion from the activity. SIGNATURE OF PARENT/GUARDIAN:
DATE:
PLAYER’S CODE OF CONDUCT: I HEREBY PLEDGE TO LIVE UP TO MY RESPONSIBILITIES AS A PLAYER PARTICIPATING IN THE DEPARTMENT OF RECREATION AND PARKS SPORTS PROGRAM BY FOLLOWING THE PLAYER’S CODE OF CONDUCT. 1. I WILL play by the rules and never argue or complain about the official’s decisions. 2. I WILL be a role model of good sportsmanship and character. I will meet my responsibilities to the coach and the team. 3. I WILL play for the fun of it and do my best to make sure that the game is fun for all participants. 4. I WILL demonstrate fair play and sportsmanship. I will treat participants, coaches, recreation administrators, and the public with respect as I would like to be treated. 5. I WILL make only positive, encouraging comments to players on both teams. I will be a good sport by cooperating with my coaches, teammates, opponents, and officials. 6. I WILL remember that the goals of the game are to have fun, improve skills, and feel good about playing. I will not take the game of myself too seriously. I will control my temper. I will work equally hard for the team as for myself, and will always give my best effort. SIGNATURE OF PLAYER:
FOR OFFICE USE ONLY:
DATE: Household ID:
Receipt #
Receipt Date:
Amount Paid:
Credit
Check #
Staff Initials:
