EFTA00295136.pdf

they. FOR YOUTH DEVELOPMENT® it FOR HEALTHY LIVING e FOR SOCIAL RESPONSIBILITY 2014 — 2015 New Canaan YMCA Basketball Information Enclosed in this package are registration materials and information for YMCA Basketball . Please note the following important dates: OCTOBER 1: Registration For All Grades Begins: Online and Front Desk Grade K-High School October 31 Registration Ends Paperwork Due Basketball Begins Basketball Ends November 1 November 17 March 14 No weekday practices for Grades K, 1, 2nd Grade Girls and High School " Evaluation Day is November 8th for Girls Grades 3-8 and Boys Grades 2-8. " If this is your first online registration attempt, members and non-members should set up an online account at least one week before October I in order to use online registration. Please refer to our website for online registration instructions. When registering online, the Basketball League can be found under Basketball League. PAPERWORK - All players must have a Basketball Information Sheet, Emergency Contact Form, Player Conflict Form (not required for oracles K. 1. 2n° Grade Girls and Hiah School). Acknowledgement of Risk and Waiver of Liability Form. Code of Conduct and payment. If paperwork is not completed by due date above the participant will not be permitted to play. Forms can be found online at the New Canaan YMCA website www.newcanaanymca.orq. or at the front desk. FEES — YMCA MEMBER: '$250.00 (2^d Grade Boys and up) $180.00 (Kindergarten, 1" Gr & 2nd Gr Girls) 'Membership must be valid through February 28, 2015 for member fee to be valid. If membership expires during basketball season It must be renewed or the non-member fee will be charged. NON-MEMBER: $375.00 (2nd Grade Boys and up) $280.00 (Kindergarten, 1" Gr & 2^d Gr Girls) FINANCIAL ASSISTANCE AVAILABLE — Please submit your Financial Assistance Request Form to Diana Riolo ext. 185 by October 1. VOLUNTEER COACHES — Anyone who is interested in becoming a volunteer coach must contact Aaron Zimmerman (azimmerman©newcanaanymca.org). The online application can be found under Social Responsibility, volunteer, click here to apply. In addition to checking the Y Ball category box, please indicate in the "Additional Comments Section" that you would like to be a Y ball coach. Once this is complete, you will be emailed a packet of paperwork to fill out and specific mandatory requirements for all Y volunteers. REFUND POLICY IS AS FOLLOWS — Parents must complete a refund request form. Full refunds will be given before basketball begins. After basketball starts, a prorated refund will be provided, less a $15 per child service charge when the space is filled. If the space is not filled, no refund will be issued. There will be no refund of league registration fee for "non-members" who change to "members" after registration ends. Please keep this form for your information. If you have any questions regarding the League, you may contact Aaron Zimmerman, Sports Director at azimmermanOnewcanaanymca.orq, (203) 966-4528 Ext. 182. Please feel free to contact Joan Cerniglia at jcerniciliaOnewcanaanvmca.orq (203) 966-4528 Ext 132 for questions regarding registration. EFTA00295136 INFORMATION SHEET NEW CANAAN YMCA BOYS & GIRLS BASKETBALL LEAGUE 2014 - 2015 OCTOBER 1: Registration For All Grades Begins; Online and Front De0 Grade Registration Ends Paperwork Due Basketball Begins Basketball Ends K-High School October 31 November 1 November 17 March 14 Name No weekday practices for Grades K, 1, 2nd Grade Sex City Girls and Age High School )OB Clearly) Grade Address Family Email The following (Please Print leagues will be offered: CLINICS BOYS GIRLS Kindergarten Clinic Boys 2nd Grade 3rd & 4th Grade Kindergarten Clinic Girls 3RD Grade 5th & 6th Grade 1st Grade Clinic Boys 4th Grade 7th & 8th Grade 1st Grade Clinic Girls 5th & 6th Grade High School (9th Grade & Up) 2nd Grade Clinic Girls 7th & 8th Grade High School (9th Grade & Up) FEES YMCA MEMBER FEE: 1250.0o (2nd Grade Boys and up) '$180.00 (Kindergarten, 1st Grade & 2nd Grade Girls) 'Membership must be valid through February 28, 2015 for member fee to be valid. If membership expires during basketball season it must be renewed or the non-member fee will be charged.' NON-MEMBER FEE: $375.00 (2i, Grade Boys and up) 5280.00 (Kindergarten, Grade & 2^I Grade Girls) PLEASE NOTE: There will be no refund of league registration fee for "non-members' who change to -members" after registration ends. "I understand that the YMCA will place my child on a team based upon his/her ability. I also understand that because of the number of children who register for this program, "special requests" cannot be honored. I fully accept my child's team placement. Parent's Signature the Date FOR YOUTH DEVELOPMENT FOR HEALTHY LIVING FOR SOCIAL RESPONSIBILITY EFTA00295137 EMERGENCY CONTACT INFORMATION Parent 1/Guardian Work # Parent 2/ Guardian Cell # Home # Work # Cell # Home # Permission Authorization I hereby certify that my child is in normal health and capable of safe participation in the youth sports program. I assume all risk(s) and hazards incidental to the conduct of this program and for the transportation to and from the program. I hereby authorize the YMCA to obtain medical treatment for my child in the event that parent(s) or the emergency contact cannot be reached." INSURANCE CO Doctor's Name Dentist's Name INSURANCE POLICY # Phone # Phone # • I understand that any expense incurred, due to the above, will be borne by the child's family. • I understand NO REFUNDS will be made unless the space is filled. (Except for verified medical reasons.) Please provide two emergency contact people, other than parents or guardians. This person should be able to respond to an emergency during the New Canaan YMCA Basketball League Season. I . Home # Relationship to child: Work/Cell # 2. Home # Relationship to child: Work/Cell # EFTA00295138 PLAYER CONFLICT FORM NEW CANAAN YMCA BOYS & GIRLS BASKETBALL LEAGUE 2014 - 2015 Please Note: The information on this form will be used during the player placement process. In order to expedite this process and avoid conflicts with a player's non-basketball schedule, please complete this form and return it by November 1. Also, please keep in mind that with the very large number of participants registered, we cannot realistically accommodate all of the "special requests" that we receive. All of the coaches in our program are VOLUNTEERS! Therefore, practice schedules are determined by the availability of the volunteer coach. So, if you are assigned a practice day which may present a conflict in your player's schedule, it is because there was not a spot on a team that worked with your child's availability. Your understanding is appreciated. PLEASE SUBMIT ONE FORM PER CHILD NOT REOUIRED FOR GRADES K. I. 2nd GRADE GIRLS & HIGH SCHOOL Name of Child: Sex: Height: Weight: Tel. # Cell # Email: (Please Print Clearly) Grade: ___ School Attending: ___ If you have a scheduling conflict please indicate the day and time below. EFTA00295139 the 1 FOR YOUTH DEVELOPMENT,' FOR HEALTHY LIVING FOR SOCIAL RESPONSIBILITY CODE OF CONDUCT FOR YOUTH AND TEENS The New Canaan YMCA is a youth-serving, community-based membership organization dedicated to providing an environment which nurtures the potential of every chid. Participation in the organization's programs is subject to the observance of the organization's rules and procedures. The activities outlined in the following list are strictly prohibited. Any program member, staff, or volunteer leader who violates this code is subject to discipline, up to and including removal from the program. • Abusive language toward a staff leader, volunteer, or another program member • Possession or use of alcoholic beverages or illegal drugs on New Canaan YMCA property or reporting to the program while under the influence of drugs or alcohol • Bringing onto YMCA property dangerous or unauthorized materials such as explosives, firearms, weapons, or other similar items • Discourtesy or rudeness to a fellow program member, staff leader, or volunteer • Verbal, physical, or visual harassment of another program member, staff leader, or volunteer • Actual or threatened violence toward any individual or group • Conduct endangering the life, safety, health, or well-being of others • Failure to follow any agency policy or procedure • Bullying or taking unfair advantage of any program member • Failing to cooperate with an adult supervisor, leader, or mentor • Not demonstrating the YMCA values of honesty, caring, respect, and responsibility I have read and I understand the New Canaan YMCA Code of Conduct for Youth and Teens. I agree to abide by the rules described above and understand that I may be removed as a participant if I violate any of these rules. 1 Youth signature Date Parent signature Date EFTA00295140 the ) V NEW CANAAN YMCA ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY NON-MEMBERS ONLY ONLY COMPLETE IF PARTICIPANT IS A NON-MEMBER To: The New Canaan YMCA, New Canaan, Connecticut, its branches, officers, directors, trustees, managers, employees, volunteer staff and agents (collectively and individually hereinafter referred to as the "Yl. The undersigned on behalf of himself/herself, and his/her minor children named below (hereinafter collectively and individually referred to as the "Releasors") acknowledges that Releasors may participate in activities involving risk of injury to person or property, and that they assume all responsibility for all such risk. Other than as set forth below, the undersigned certifies that each of the Releasors is in good health with no condition, illness or abnormality which might subject them to undue personal risk from engaging in such activities. In the event of any emergency requiring medical care, the Y is hereby authorized to use it best efforts to obtain whatever medical treatment it deems necessary or appropriate under the circumstances. Furthermore, to the extent permitted by law, the undersigned on behalf of the Releasors hereby specifically releases, waives, discharges and covenants not to sue the Y with respect to any or all liability to the Releasors, their heirs, personal representatives and assigns for any loss or damage, and any claim or demand therefore, on account of injury to person or property, including death unless caused by the gross negligence or willful misconduct of the Y or its employees while Releasors are in, on or about any premises of the Y or using any of the Y's facilities or equipment or participating in any program affiliated with the Y, without regard to location. The undersigned expressly agrees that the foregoing Waiver of Liability is intended to be as broad and inclusive as is permitted by the law of the State of Connecticut and that if any portion thereof is held invalid, the undersigned agrees that the balance shall; notwithstanding, continue in full force and effect. The undersigned understands that the Y has the right to dismiss any person whose actions or attitude are deemed detrimental to the Y and/or other participants, with all fees forfeited. NAME OF PARTICIPANT of Program/Activity (Print Name): DATE OF BIRTH OF PARTICIPANT PARENT/GUARDIAN (If participant is under 18ys of age) Print Name: Emergency Contact: Name: Phone: Name: Phone: Medical Concerns: If emergency contact or medical concerns change, the undersigned accepts the responsibility for notifying the Y in writing of this change. The undersigned gives permission for photos or videotapes of himself/herself and his/her children named below while participating in Y activities to be used for promotional purposes. (Cross out and if permission not given.) THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THIS ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY, AND FURTHER AGREES THAT NO REPRESENTATIONS OR STATEMENTS OTHER THAN THOSE SET FORTH HEREIN HAVE BEEN MADE. PLEASE PRINT NAME CLEARLY: Date: Attn: K. Morrissey Signature (must be 18 years of age or older) PROGRAM/ACTIVITY NAME: BASKETBALL Last revised 12/11 EFTA00295141