AVON LITTLE LEAGUE 2018 SAFETY MANUAL. League ID Number OHIO DISTRICT #3 PLAY HARD-PLAY SAFE-HAVE FUN EFFECTIVE FROM:

Size: px
Start display at page:

Download "AVON LITTLE LEAGUE 2018 SAFETY MANUAL. League ID Number OHIO DISTRICT #3 PLAY HARD-PLAY SAFE-HAVE FUN EFFECTIVE FROM:"

Transcription

1 AVON LITTLE LEAGUE 2018 SAFETY MANUAL League ID Number OHIO DISTRICT #3 PLAY HARD-PLAY SAFE-HAVE FUN EFFECTIVE FROM: APRIL 1, 2018 THRU MARCH 31,

2 TABLE OF CONTENTS Section Pages 1. Safety Officer/Safety Committee 3 2. Manager and Coach Safety Manual 4 3. Emergency and Key Officials Telephone Numbers 5 4. Little League Volunteer Application Form 6 5. Manager/Coaches Training - Fundamentals 7 6. First Aid Training - Managers and Coaches 8 7. Field Inspections 9 8. Little League Annual Facility Survey Concession Stand Safety Procedures Equipment Inspection and Replacement Accident Reporting/Tracking Procedures 13, First Aid Kits Enforcing Little League Rules Parent Code of Conduct League Player Registration Data or Player Roster Data And Coach and Manager Data Ideas Implemented to Promote or Improve Safety Plan 19 Appendices Appendix A - Copy of Managers and Coaches Safety Manual Appendix B - Copy of Volunteer Applications Appendix C - Copy of Accident Notification Form Appendix D - What Parents Should Know About Little League Insurance 2

3 SECTION 1 SAFETY OFFICER Every year Avon Little League will offer a position of Safety Officer on the Avon Little Board. If, for whatever reason, no one will accept the responsibility of Safety Officer, the League Vice President will assume the role. When the Safety Officer is elected on to the Avon Little League Board, he/she will be responsible for the safety of the League. The responsibilities of the Safety Officer include: Request a Safety Committee to be established comprised of other Avon Little League Board members. All work associated with the requirements of ASAP - A Safety Awareness Program. (See Section 8) All work associated with schedule of manager and coach training. (See Section 6) All work associated with acquiring the scheduling of Little League player safety training through the managers and coaches. All work associated with acquiring the proper individuals to perform safety training. Make sure that the position of Safety Officer s name is submitted and on file with Little League headquarters. Distribute the pertinent safety materials. Within 48 hours of receiving an incident report from the manager or coach he/she will contact the injured party or the injured party s parent(s) to (i) verify information received, (ii) obtain any other pertinent information, (iii) check on the status of the player, manager, coach, umpire, and (iv) if additional medical attention was required advise the injured party or injured party s parent of Avon Little League insurance coverage. Set a yearly budget amount with the Avon Little League Board for continued Safety Awareness. Determine the number of First Aid kits required (one per team) and have sufficient spare components for future replacement. Provide the necessary information Concession Stand Safety and Cleaning requirements, if Concession Stands are operated by Avon Little League. Provide the necessary information for the Equipment Shed and the equipment. Provide the necessary information for the materials used on the playing fields. Track all injuries and make reports to Little League Headquarters when required. Work in conjunction with all members of the Avon Little League Board and other volunteers to assure safe practices of all players, managers and coaches. Forward a copy of the Avon Little League Safety Manual to the District Administrator for their review. At the end of the season, reacquire the First Aid Kits and prepare a list of First Aid Kits needed for following year and present to Avon Little League Board. 3

4 SECTION 2 SAFETY MANUAL Every year Avon Little League will supply a Safety Manual to all managers and coaches. The manual will include all relevant materials for the managers and coaches to enable them to perform the proper functions when an accident occurs. The Safety Manual for Managers and Coaches will include: Safety rules of Avon Little League What to Do and What Not to Do A list of emergency telephone numbers and Avon Little League Board contact information Avon Little League Code of Conduct Player Code of Conduct Parent Code of Conduct Procedures regarding Communicable Diseases Accident reporting procedures Expectations of managers, coaches, players and parents Equipment shed procedures Safety and Fundamental clinic reminders Lightning facts and safety information Conditioning, Stretching and Hydration Appendix A includes the Avon Little League Safety Manual for Managers and Coaches 4

5 SECTION 3 EMERGENCY AND KEY OFFICIALS TELEPHONE NUMBERS EMERGENCY TELEPHONE NUMBERS: Avon Police (Emergency): 911 Avon Police (Non-Emergency) Avon Fire Dept./EMT: AVON LITTLE LEAGUE TELEPHONE NUMBERS IN CASE OF AN INJURY, PLEASE CONTACT THE AVON LITTLE LEAGUE SAFETY OFFICER Greg Dziak: Position Name Telephone Number President Michael Love Player Agent Brian Schulenberg Vice President - Baseball Jason Hirz Vice President - Softball Beth Hauk Treasurer Matt Baker Safety Officer Greg Dziak Umpire In Chief Ron Stitchick

6 SECTION 4 VOLUNTEER APPLICATION Little League International requires mandatory Sexual Offender Registry Checks on all Board Members, League Officers, Managers and Coaches. In order to accomplish this task, Avon Little League will use the approved Little League Volunteer Application or Little League Returning Volunteer Application. If an individual does not want to fill out either Volunteer Application, they will not be allowed to Manage, Coach, or be a Board Member or League Officer of Avon Little League regardless of reason. At no time, will the Members of the Avon Little League Board release information regarding the Volunteer Application once the authority performing the background check has processed them. The President, Vice President or Safety Officer of Avon Little League will be assigned the task of performing the Sexual Offender Registry Checks. The individual performing the background checks shall not conduct their own background check. All questions from volunteers concerning background checks should be directed to the Avon Little League President or Vice President. Appendix B includes the Little League Volunteer Application and the Little League Returning Volunteer Application. 6

7 SECTION 5 MANAGER/COACH FUNDAMENTALS TRAINING Avon Little League will provide training for the Managers and Coaches of Avon Little League. This training is mandatory for at least one manager or one coach of every team. If only one member per team is at training, it is expected that the member in attendance forward the information to the other coach to enable continuity. The Avon Little League Board will determine the dates of the Fundamentals Training and the acquisition of qualified individual(s) to provide the training. Avon Little League is attempting to raise the capabilities of the players to perform at the best that they can be. Some volunteers offer their time to manager or coach, but they may not have the background for teaching the proper baseball techniques. These training clinics will allow volunteers to learn and deploy that information and it may also reinforce other volunteers. It is the intent of Avon Little League to provide the same training techniques to all players allowing for player improvement through the course of the season. 7

8 SECTION 6 FIRST AID TRAINING FOR MANAGERS AND COACHES Avon Little League will provide First Aid Training for the Managers and Coaches of Avon Little League. This training is mandatory for at least one manager or one coach of every team. If only one member per team is at the training, it is expected that the member in attendance forward the information to the other coach to enable continuity. The Avon Little League Board will determine when the First Aid Training and the acquisition of qualified individual(s) to perform the training. 8

9 SECTION 7 FIELD INSPECTIONS It is the overall responsibility of the members of the Avon Little League Board to oversee the condition of all fields under the Avon Little League jurisdiction. For games played in other communities it is the responsibility of the person in charge of that community s fields to assure the safety of all players. Additionally, it is the responsibility of each Home Team Manager or Coach to walk the field before every game or practice to identify any potential risks (rocks, holes, glass, etc.). If small holes are found the Manager or Coach should try and fill the hole in as best as possible. Rocks, glass or other debris should be disposed of appropriately. At the end of every game or practice, each team is responsible for cleaning their dugout and surrounding area around dugout. All trash should be discarding in a garbage can. If garbage cans are full, please take the trash to dumpster. A clean environment is a safe environment. 9

10 SECTION 8 ASAP LITTLE LEAGUE ANNUAL FACILITY SURVEY AND SAFETY PLAN REGISTRATION FORM It is the responsibility of the Avon Little League Safety Officer to fill out all forms regarding ASAP (A Safety Awareness Program). This will allow Avon Little League to receive a credit from Little League Corporate. The Avon Little League Safety Officer should meet with the Avon Little League Board to determine if all of the information is correct before submitting the program to Little League headquarters. Additionally, any information found through the course of preparing the ASAP program should be discussed to determine if any amendments are required. It is a yearly responsibility of the Avon Little League Safety Officer to review the established guidelines and determine where improvements can be made to the Avon Little League ASAP program. This information can be obtained through personal observation or from other volunteers to be brought to the Board s attention for approval. 10

11 SECTION 9 CONCESSION STAND Avon Little League does not have concession stands. The concession stands are operated by a third party not affiliated with Avon Little League. 11

12 SECTION 10 EQUIPMENT INSPECTION AND REPLACEMENT The Avon Little League Equipment Manager is responsible for all equipment before the season commences. The Avon Little League Equipment Manager is responsible in determining if the equipment can be reused in future Little League seasons. All equipment will be cleaned before each season. The team manager will check equipment for the players (helmets, bats, catcher s equipment, etc.) before every game or practice. At no time will equipment be used if it is found defective. The minor and major league umpires are responsible for their equipment before every game. At the season s end, the team managers will return all the equipment provide by Avon Little League to the Avon Little League Equipment Manager at a time and place designated by the Avon Little League Equipment Manager. The Avon Little League Equipment Manager shall keep a checklist of equipment given to team managers and shall at the end of every season check the list against the equipment returned by the team manager. At the end of the season the Avon Little League Equipment Manager shall store all of the equipment in the equipment shed for following season. All equipment found to be defective and suitable for use during the course of the season will be returned immediately to the Avon Little League Equipment Manager. The Avon Little League Equipment Manager will provide the team manager a replacement piece of equipment for use during the duration of the season. All equipment found to be defective and unable to be fixed to be used the following season shall be discarded by the Avon Little League Equipment Manager. 12

13 SECTION 11 ACCIDENT REPORTING AND TRACKING PROCEDURE An incident that causes a player, manager, coach, umpire or volunteer to receive medical treatment and/or first aid must be reported to the Avon Little League Safety officer. This includes even passive treatments such as the evaluations and diagnosis of the extent of the injury. All incidents described above must be reported to the Avon Little League Safety Officer within 24 hours of the incident. The Avon Little League Safety Officer, Greg Dziak, can be reached at the following: Phone: gjdziak@yahoo.com The Avon Little League Safety Officer s contact information will be posted at all times at the Concession Stands. Reporting incidents can come in a variety of forms. Most typically, there will be a phone conversation. At a minimum, the following information must be provided: The name and telephone number of the individual involved. The date, time and location of the incident. As detailed a description of the incident as possible. The preliminary estimation of the extent of any injuries. The name and telephone number of the person reporting the incident. Within 48 hours of receiving the accident report, the Avon Little League Safety Officer will contact the injured party or the party s parents and: Verify the information received. Obtain any other information deemed necessary. Check on the status of the injured party. In the event that the injured party required other medical treatment (i.e. emergency room visit, doctor s visit, etc.) the Avon Little League Safety Officer will advise the parent or guardian of Avon Little League s insurance coverage and the provisions for submitting any claims. If the extent of the injuries are more than minor in nature, the Avon Little League Safety Officer shall periodically call the injured party to: Check on the status of any injuries. Check if any other assistance is necessary in areas such as submission of insurance forms, etc., until such time as the incident is considered closed (i.e. no further claims are expected and/or individual is participating in league again). 13

14 INSURANCE POLICIES Little League accident insurance covers only those activities approved or sanctioned by Little League International. EXPLANATION OF COVERAGE: The Little League International Insurance Program is designed to afford protection to all participants at the most economical cost to Avon Little League. The Little League Player Accident Policy is an excess coverage, accident only plan, to be used as a supplement to other insurance carried under a family policy or insurance provided by an employer. If there is no primary coverage, Little League insurance, which is purchased by Avon Little League, will provide benefits for eligible charges, up to Usual and Customary allowances. A $50.00 deductible applies for all claims, up to the maximum stated benefits. This plan makes it possible to offer exceptional, affordable protection with assurance to parents that adequate coverage is in force at all time during the season. When filing a claim (see claim form in Appendix D) all medical costs should be fully itemized. If no other insurance is in effect, a letter from the parent s, guardian s or claimant s employer explaining the lack of Group or Employer insurance must accompany a claim form. Additional information regarding Little League Insurance can be found under Appendix E. 14

15 SECTION 12 FIRST AID KITS First Aid Kits will be furnished to each team at the beginning of the season. The First Aid Kit will become a part of the team s equipment package and shall be taken to all practices and games (whether season or post season) and any other Avon Little League event where children s safety is at risk. To replenish materials in the First Aid Kit, the team manager must contact either the Avon Little League Safety Officer of the Avon Little League Equipment Manager. Additional First Aid Kits will be placed at the Concession Stands at Avon Little League Park and Veteran s Park. If the person injured is conscious, you must have that person s permission before administering first aid. To get permission you must tell the injured person who you are, how much training you have, and how you plan to help. Only then can a conscious victim give you permission to give care. Do not give first aid care to a conscious injured person who refuses your offer to give help. If the conscious injured person is an infant or child, permission to give care should be obtained from a supervising adult when one is available. If the condition is serious, permission is implied if a supervising adult is not present. In order for any child to play in Avon Little League, they must have a completed Medical Release Form from their parent or guardian. It is the team manager s responsibility to carry that form to every practice, game or other Avon Little League event. 15

16 SECTION 13 ENFORCING LITTLE LEAGUE RULES The intent of the Avon Little League Safety Manuel is to promote safety awareness to the athletes and volunteers of Avon Little League. If any codes of conduct, or safety guidelines are disregarded by any volunteer or athlete, the individual in error will appear before the Avon Little League Board for the appropriate disciplinary measures. At that time, the offender will have the right to present his or her case. After hearing the situation regarding the incident, the Avon Little League Board will make a decision as to what, if any, disciplinary action to take against the offender. 16

17 SECTION 14 PARENT CODE OF CONDUCT Avon Little League requires all parents to sign a Sport Parent Code of Conduct in order for their child to participate in our program. 17

18 SECTION 15 LEAGUE PLAYER REGISTRATION DATA OR PLAYER ROSTER DATE AND COACH AND MANAGER DATA Little League International requires that player, manager and coach data be supplied annually in order to receive an approved ASAP Plan. Avon Little League complies with this annual requirement by submitting the required data online via the Little League Data Center at 18

19 SECTION 16 IDEAS IMPLEMENTED TO PROMOTE OR IMPROVE SAFETY PLAN Avon Little League has implemented a Parent Code of Conduct that all parents must sign in order for their child to participate in Avon Little League. The idea is to promote sportsmanship among our youth athletes and to stress the importance that this a game for the children. 19

20 APPENDIX A Managers and Coaches Safety Manual 20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41 APPENDIX B Volunteer Applications 21

42 22

43 23

44 APPENDIX C Copy of Accident Notification Form 24

45 25

46 APPENDIX D WHAT PARENTS SHOULD KNOW ABOUT LITTLE LEAGUE INSURANCE 26

47 It is suggested this memo should be reproduced on your league s letterhead over the signature of your president or safety officer and distributed to the parents of all participants at registration time. WARNING: Protective equipment cannot prevent all injuries a player might receive while participating in Baseball / Softball. WHAT PARENTS SHOULD KNOW ABOUT LITTLE LEAGUE INSURANCE The Little League Insurance Program is designed to afford protection to all participants at the most economical cost to the local league. The Little League Player Accident Policy is an excess coverage, accident only plan, to be used as a supplement to other insurance carried under a family policy or insurance provided by an employer. If there is no primary coverage, Little League insurance will provide benefits for eligible charges, up to Usual and Customary allowances for your area. A $50 deductible applies for all claims, up to the maximum stated benefits. This plan makes it possible to offer exceptional, affordable protection with assurance to parents that adequate coverage is in force for all chartered and insured Little League approved programs and events. If your child sustains a covered injury while taking part in a scheduled Little League Baseball or Softball game or practice, here is how the insurance works: 1. The Little League Baseball and Softball accident notification form must be completed by parents (if the claimant is under 19 years of age) and a league official and forwarded directly to Little League Headquarters within 20 days after the accident. A photocopy of the form should be made and kept by the parent/claimant. Initial medical/dental treatment must be rendered within 30 days of the Little League accident. 2. Itemized bills, including description of service, date of service, procedure and diagnosis codes for medical services/ supplies and/or other documentation related to a claim for benefits are to be provided within 90 days after the accident. In no event shall such proof be furnished later than 12 months from the date the initial medical expense was incurred. 3. When other insurance is present, parents or claimant must forward copies of the Explanation of Benefits or Notice/ Letter of Denial for each charge directly to Little League International, even if the charges do not exceed the deductible of the primary insurance program. 4. Policy provides benefits for eligible medical expenses incurred within 52 weeks of the accident, subject to Excess Coverage and Exclusion provisions of the plan. 5. Limited deferred medical/dental benefits may be available for necessary treatment after the 52-week time limit when: (a) Deferred medical benefits apply when necessary treatment requiring the removal of a pin /plate, applied to transfix a bone in the year of injury, or scar tissue removal, after the 52- week time limit is required. The Company will pay the Reasonable Expense incurred, subject to the Policy s maximum limit of $100,000 for any one injury to any one Insured. However, 27

48 in no event will any benefit be paid under this provision for any expenses incurred more than 24 months from the date the injury was sustained. (b) If the Insured incurs Injury, to sound, natural teeth and Necessary Treatment requires treatment for that Injury be postponed to a date more than 52 weeks after the injury due to, but not limited to, the physiological changes of a growing child, the Company will pay the lesser of: 1. A maximum of $1,500 or 2. Reasonable Expenses incurred for the deferred dental treatment. Reasonable Expenses incurred for deferred dental treatment are only covered if they are incurred on or before the Insured s 23rd birthday. Reasonable Expenses incurred for deferred root canal therapy are only covered if they are incurred within 104 weeks after the date the Injury occurs. No payment will be made for deferred treatment unless the Physician submits written certification, within 52 weeks after the accident, that the treatment must be postponed for the above stated reasons. Benefits are payable subject to the Excess Coverage and the Exclusions provisions of the Policy. We hope this brief summary has been helpful in providing a better understanding of the operation of the Little League insurance program. 28

MANDATORY COVERAGE. 2a. General Liability Insurance (GL)

MANDATORY COVERAGE. 2a. General Liability Insurance (GL) INSURANCE THE AIG GROUP INSURANCE PROGRAM IS SPECIALLY DESIGNED FOR CHARTERED LITTLE LEAGUES TO CREATE AFFORDABLE PROTECTION FOR ALL ELIGIBLE PARTICIPANTS AND LOWER PROGRAMS COSTS TO LOCAL LEAGUES. Leagues

More information

THE AIG GROUP INSURANCE PROGRAM

THE AIG GROUP INSURANCE PROGRAM THE AIG GROUP INSURANCE PROGRAM IS SPECIALLY DESIGNED FOR CHARTERED LITTLE LEAGUES TO CREATE AFFORDABLE PROTECTION FOR ALL ELIGIBLE PARTICIPANTS AND LOWER PROGRAM COSTS TO LOCAL LEAGUES. INSURANCE Online

More information

Warwick, Rhode Island

Warwick, Rhode Island Warwick, Rhode Island Safety Plan: Welcome Page 1 Warwick North Little League Significant enhancements and changes for the 2015 season Merge Little League International has recently approved the merge

More information

SALEM RECREATION COMMISSION MEMORANDUM OF UNDERSTANDING. Adopted: April 21, 2014

SALEM RECREATION COMMISSION MEMORANDUM OF UNDERSTANDING. Adopted: April 21, 2014 SALEM RECREATION COMMISSION MEMORANDUM OF UNDERSTANDING Adopted: April 21, 2014 Sue Spang, Chairman Bob Appleby Jim Burke Pam Henry Dave Kennedy Al Giansanti Doug Morrow Salem Recreation Commission Memorandum

More information

RISK MANAGEMENT MANUAL

RISK MANAGEMENT MANUAL SECTION 1 RISK MANAGEMENT RISK MANAGEMENT MANUAL 1.01 INTRODUCTION TO RISK MANAGEMENT.PAGE 2 SECTION 2 INSURANCE 2.01 MEMBERSHIP BENEFITS..PAGE 3 2.02 INSURANCE OVERVIEW... PAGE 3 2.03 ACCIDENT COVERAGE

More information

AMATEUR BASEBALL, SOFTBALL & T-BALL

AMATEUR BASEBALL, SOFTBALL & T-BALL AMATEUR BASEBALL, SOFTBALL & T-BALL LOOK OUT! DOESN T HAVE TO BE SO PAINFUL GROUPROTECTOR SM Group Accident Medical Insurance QUOTE & BIND ONLINE Scan this code or go to www.nationwide.com/grouprotector

More information

MIDLOTHIAN PARKS & RECREATION DEPARTMENT YOUTH SPORTS ASSOCIATIONS FACILITY USE AGREEMENT

MIDLOTHIAN PARKS & RECREATION DEPARTMENT YOUTH SPORTS ASSOCIATIONS FACILITY USE AGREEMENT MIDLOTHIAN PARKS & RECREATION DEPARTMENT YOUTH SPORTS ASSOCIATIONS FACILITY USE AGREEMENT THIS AGREEMENT is made by and between the City of Midlothian, Texas (the City ) and, hereinafter referred to as

More information

Cape Elizabeth Town & School

Cape Elizabeth Town & School Cape Elizabeth Town & School Use of Facilities Guidelines & Procedures It is the philosophy of the Town of Cape Elizabeth, its town and school officials, that our school and town buildings are community

More information

EXTENDED STUDENT SERVICES ASES GRANT AFTER SCHOOL ENRICHMENT PROGRAM (Lakeside Middle School - ASES - LATER Program Only)

EXTENDED STUDENT SERVICES ASES GRANT AFTER SCHOOL ENRICHMENT PROGRAM (Lakeside Middle School - ASES - LATER Program Only) EXTENDED STUDENT SERVICES 2017-2018 ASES GRANT AFTER SCHOOL ENRICHMENT PROGRAM (Lakeside Middle School - ASES - LATER Program Only) Children Registration & Emergency Information (One form per child is

More information

City of Grand Island

City of Grand Island City of Grand Island Tuesday, February 26, 2008 Council Session Item G10 #2008-63 - Approving Policies and Procedures for Use of Parks & Recreation Facilities Staff Contact: Steve Paustian City of Grand

More information

Coronado Islanders Rugby

Coronado Islanders Rugby 2016-17 Registration Packet Checklist Please complete and sign the following forms (check circles as you complete) o Registration o Waiver o Code of Conduct Please provide us with the following information*

More information

USSSA Insurance. Frequently Asked Questions FILICE INSURANCE AGENCY

USSSA Insurance. Frequently Asked Questions FILICE INSURANCE AGENCY USSSA Insurance 2009 Frequently Asked Questions FILICE INSURANCE AGENCY 1 TABLE OF CONTENTS GENERAL INFORMATION 3 PRIVATE FIELD/FACILITY OWNER PROGRAM 5 PUBLIC FIELD/FACILITY OWNER PROGRAM 10 TEAM INSURANCE

More information

USSSA Insurance. Frequently Asked Questions. EPIC Brokers

USSSA Insurance. Frequently Asked Questions. EPIC Brokers USSSA Insurance 2016 Frequently Asked Questions EPIC Brokers 1 TABLE OF CONTENTS GENERAL INFORMATION Page 3 PUBLIC/PRIVATE FIELD/FACILITY OWNER POLICY Page 5 TEAM INSURANCE Page 9 TOURNAMENT INSURANCE

More information

Athletic Facility Policies & Procedures

Athletic Facility Policies & Procedures Athletic Facility Policies & Procedures Town of Fuquay-Varina Parks, Recreation & Cultural Resources Department 401 Old Honeycutt Road Fuquay-Varina, North Carolina 27526 Phone: 919-552-1430 Fax: 919-557-3112

More information

GROUPROTECTOR SM AMATEUR BASKETBALL WE LL KEEP YOU COVERED SO YOU CAN QUICKLY REBOUND. Group Accident Medical Insurance

GROUPROTECTOR SM AMATEUR BASKETBALL WE LL KEEP YOU COVERED SO YOU CAN QUICKLY REBOUND. Group Accident Medical Insurance AMATEUR BASKETBALL WE LL KEEP YOU COVERED SO YOU CAN QUICKLY REBOUND GROUPROTECTOR SM Group Accident Medical Insurance QUOTE & BIND ONLINE Scan this code or go to www.nationwide.com/grouprotector ACCIDENTS

More information

Rosetta Canyon Sports Park Policies and Fees

Rosetta Canyon Sports Park Policies and Fees Rosetta Canyon Sports Park Policies and Fees Description The intention of the Rosetta Canyon Sports Park is to provide industry leading facilities for sporting practices, games and tournaments. Through

More information

Educational Visits School Policy

Educational Visits School Policy Educational Visits School Policy This document covers all types of educational visit, including short, local visits on foot, day trips and residential trips. This document is intended to be read in conjunction

More information

GROUPROTECTOR SM AMATEUR FLAG, TAG, TOUCH & TACKLE FOOTBALL KEEP YOUR HEAD IN THE GAME WE LL KEEP YOU COVERED. Group Accident Medical Insurance

GROUPROTECTOR SM AMATEUR FLAG, TAG, TOUCH & TACKLE FOOTBALL KEEP YOUR HEAD IN THE GAME WE LL KEEP YOU COVERED. Group Accident Medical Insurance AMATEUR FLAG, TAG, TOUCH & TACKLE FOOTBALL KEEP YOUR HEAD IN THE GAME WE LL KEEP YOU COVERED GROUPROTECTOR SM Group Accident Medical Insurance QUOTE & BIND ONLINE Scan this code or go to www.nationwide.com/grouprotector

More information

Junior Baseball Spring 2018 Ages 8 & 9

Junior Baseball Spring 2018 Ages 8 & 9 ACTIVITY NUMBER: 10402 Department of Parks & Recreation Recreation Division 101 Field Point Road - Greenwich, CT 06836-2540 Phone: (203) 618-7649 Email: Recreation@greenwichct.org Junior Baseball Spring

More information

Health Care Benefits. Important!

Health Care Benefits. Important! Health Care Benefits The Major League Baseball Players Welfare Plan (referred to as the Welfare Plan in this section) provides comprehensive health care benefits for you and your eligible dependents. Whether

More information

2017 Clinic Boys 8-12

2017 Clinic Boys 8-12 Department of Parks & Recreation Recreation Division 101 Field Point Road - Greenwich, CT 06836-2540 Phone: (203) 618-7649 Email: Recreation@greenwichct.org 2017 Clinic Boys 8-12 ACTIVITY NUMBER: 30401

More information

NOTICE OF PRIVACY PRACTICES Total Sports Care, P.C.

NOTICE OF PRIVACY PRACTICES Total Sports Care, P.C. NOTICE OF PRIVACY PRACTICES Total Sports Care, P.C. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

More information

USSSA INSURANCE 2017 FREQUENTLY ASKED QUESTIONS. Edgewood Partners Insurance Center CA License 0B29370

USSSA INSURANCE 2017 FREQUENTLY ASKED QUESTIONS. Edgewood Partners Insurance Center CA License 0B29370 USSSA INSURANCE 2017 FREQUENTLY ASKED QUESTIONS TABLE OF CONTENTS GENERAL INFORMATION... 3 PUBLIC/PRIVATE FIELD FACILITY OWNER POLICY... 4 TEAM/LEAGUE INSURANCE... 6 TOURNAMENT INSURANCE... 10 OFFICALS

More information

NON-INSTRUCTIONAL TRANSPORTATION: COMMUNITY PROGRAMS AND FAMILY CENTRES EEAG. APPROVED: November 1, Legal References: Province of Manitoba

NON-INSTRUCTIONAL TRANSPORTATION: COMMUNITY PROGRAMS AND FAMILY CENTRES EEAG. APPROVED: November 1, Legal References: Province of Manitoba NON-INSTRUCTIONAL TRANSPORTATION: COMMUNITY APPROVED: November 1, 2016 REVISED: EEAG Legal References: Province of Manitoba Guideline Statement The Louis Riel School Division provides valuable services

More information

Any losses in the last 3 years? Yes No Any losses in the last 3 years? Yes No. If yes, please include complete loss history for all coverages.

Any losses in the last 3 years? Yes No Any losses in the last 3 years? Yes No. If yes, please include complete loss history for all coverages. Date Prepared: / / General Information Name of Sports Academy Contact Name Title Address City State Zip Mailing Address City State Zip Telephone ( ) Fax ( ) E-mail Address Applicant is: Individual Corporation

More information

Accident Report Cover Sheet

Accident Report Cover Sheet Accident Report Cover Sheet Employee Name: Social Security #: Address: Phone Number: D.O.B.: Marital Status: Dependents: Date Employee first started working for Kaye Personnel: (not at incident site, but

More information

Town of Vernon Park & Rec Activity Guide

Town of Vernon Park & Rec Activity Guide 2019 Town of Vernon Park & Rec Activity Guide Soccer Registration Deadline: March 1st - End of Day Baseball / Softball Registration Deadline: March 22nd - End of Day Non-Resident Fee $15/child or $23/family

More information

BOARD OF EDUCATION Toms River Regional Schools Toms River, New Jersey 08753

BOARD OF EDUCATION Toms River Regional Schools Toms River, New Jersey 08753 INTERMEDIATE COACH PACKET (94) BOARD OF EDUCATION Toms River Regional Schools Toms River, New Jersey 08753 I do hereby authorize the principal of Intermediate East/North/South School to permit my child

More information

Sponsored Extended Trip or Tour Request for Final Approval ct Guidelines and Checklist FORM A

Sponsored Extended Trip or Tour Request for Final Approval ct Guidelines and Checklist FORM A Sponsored Extended Trip or Tour Request for Final Approval ct Guidelines and Checklist FORM A METROPOLITAN SCHOOL DISTRICT t Dayton Street Madison, WI 53703 Below are instructions and a checklist of the

More information

RISK MANAGEMENT IS FOR EVERYONE. Be Prepared

RISK MANAGEMENT IS FOR EVERYONE. Be Prepared RISK MANAGEMENT IS FOR EVERYONE Be Prepared SO JUST WHAT DOES RISK MANAGEMENT MEAN? What is Risk? Risk is the uncertainty about a future event that threatens an organization s ability to accomplish its

More information

ALL SPORTS STRENGTH AND CONDITIONING CAMP

ALL SPORTS STRENGTH AND CONDITIONING CAMP U n i v e r s i t y o f W a s h i n g t o n H u s k i e s ALL SPORTS STRENGTH AND CONDITIONING CAMP SATURDAY JUNE 1st, 2013 9-11am: grades 6-8 11:30-1:30pm; grades 9-10 2-4pm: grades 11-12 It s back for

More information

Field Trips Safety and Paperwork. Girl Scouts of Central and Western Massachusetts

Field Trips Safety and Paperwork. Girl Scouts of Central and Western Massachusetts Field Trips Safety and Paperwork Girl Scouts of Central and Western Massachusetts This Field Trip Course is composed of two modules: Field Trips: Safety and Paperwork and Field Trips: Planning. Prerequisites:

More information

THE USPC INSURANCE PLAN

THE USPC INSURANCE PLAN Revised 1-1-2018 1 Revised 1-1-2018 2 USPC INSURANCE PLAN an open clinic or horse show). This can be accomplished by completing the online Optional Medical/ Accident application located under the Parent/Volunteer

More information

Saint Louis University Notice of Privacy Practices Effective Date: April 14, 2003 Amended: September 22, 2013

Saint Louis University Notice of Privacy Practices Effective Date: April 14, 2003 Amended: September 22, 2013 Saint Louis University Notice of Privacy Practices Effective Date: April 14, 2003 Amended: September 22, 2013 This notice describes how medical information about you may be used and disclosed and how you

More information

It is STRONGLY RECOMMENDED each player secure their own batting helmet for sanitary reasons.

It is STRONGLY RECOMMENDED each player secure their own batting helmet for sanitary reasons. Interested in making extra money this summer? We are always looking for help umpiring, working the concession stand and field maintenance. Applications can be found in the About tab under the Downloaded

More information

Policy Regulating Use of Gibbsboro Municipal Facilities

Policy Regulating Use of Gibbsboro Municipal Facilities Policy Regulating Use of Gibbsboro Municipal Facilities Gibbsboro Borough 49 Kirkwood Road Gibbsboro, NJ 08026 (856)783-6655 REVISED MAY 2011 PAGE 1 REV. 5 GIBBSBORO MUNICIPAL FACILITIES SCOPE: The Borough

More information

NATIONS BASEBALL INSURANCE QUESTIONS & ANSWERS CHAPPELL INSURANCE AGENCY, INC. K & K INSURANCE GROUP

NATIONS BASEBALL INSURANCE QUESTIONS & ANSWERS CHAPPELL INSURANCE AGENCY, INC. K & K INSURANCE GROUP NATIONS BASEBALL INSURANCE QUESTIONS & ANSWERS CHAPPELL INSURANCE AGENCY, INC. K & K INSURANCE GROUP TABLE OF CONTENTS PAGE GENERAL INFORMATION 3 CERTIFICATES OF INSURANCE 4 TEAM INSURANCE 5 TOURNAMENT

More information

AIG INSURANCE SPORTS GENERAL LIABILITY CAMP/CLINIC/SPECIAL EVENT/TOURNAMENT APPLICATION DBA: 3. Mailing Address: Physical Address 2:

AIG INSURANCE SPORTS GENERAL LIABILITY CAMP/CLINIC/SPECIAL EVENT/TOURNAMENT APPLICATION DBA: 3. Mailing Address: Physical Address 2: AIG INSURANCE SPORTS GENERAL LIABILITY CAMP/CLINIC/SPECIAL EVENT/TOURNAMENT APPLICATION Application Instructions A. Please type or complete the application in ink. B. If additional space is needed, please

More information

SPECIAL EVENT CHECKLIST

SPECIAL EVENT CHECKLIST POLICIES AND GUIDELINES Special Events sponsored by Chapters, Districts, and Regions are covered under the General Liability policy provided by Alpha Phi Alpha Fraternity, Inc. If any event other than

More information

South Dakota Workers Compensation System

South Dakota Workers Compensation System An Employee s Guide to the South Dakota Workers Compensation System Division of Labor and Management 123 W. Missouri Ave. Pierre, SD 57501 Tel: 605.773.3681 sdjobs.org This booklet briefly outlines South

More information

DISABILITY RETIREMENT IS A TWO STEP PROCESS

DISABILITY RETIREMENT IS A TWO STEP PROCESS Baltimore, Maryland 21202-6700 410-625-5555 or toll free 1-800-492-5909 DISABILITY RETIREMENT IS A TWO STEP PROCESS First, you must file your initial claim package and supply whatever documentation is

More information

AMATEUR SPORTS ASSOCIATION INSURANCE APPLICATION

AMATEUR SPORTS ASSOCIATION INSURANCE APPLICATION AMATEUR SPORTS ASSOCIATION INSURANCE APPLICATION SUBMISSION REQUIREMENTS Completed signed / dated Supplemental Applications Completed ACORD Applications (Property, Auto and Umbrella Liability) if coverages

More information

RPS Bollinger Sports & Leisure Amateur Sports Insurance Application

RPS Bollinger Sports & Leisure Amateur Sports Insurance Application RPS Bollinger Sports & Leisure Amateur Sports Insurance Application Date Prepared: / / General Information Name of Insured: Contact Name: Title: Address: City: State: Zip: Mailing Address: City: State:

More information

World Bank Group Directive

World Bank Group Directive World Bank Group Directive Staff Rule 6.11 - Workers' Compensation Program Bank Access to Information Policy Designation Public Catalogue Number HRD3.03-DIR.114 Issued March 13, 2017 Effective October

More information

STUDENT ACCIDENT REPORTING PROCEDURES INFORMATION SHEET

STUDENT ACCIDENT REPORTING PROCEDURES INFORMATION SHEET Dear Parents, STUDENT ACCIDENT REPORTING PROCEDURES INFORMATION SHEET Your School Board continues to be vitally concerned about the health, safety, and welfare of all students. We encourage safety, but

More information

Volunteer Drivers: Information and Application

Volunteer Drivers: Information and Application SOU WEST NOVA TRANSIT ASSOCIATION Volunteer Drivers: Information and Application Thank you for your interest in becoming a volunteer for the Volunteer Driver Program! The contributions of people like you

More information

AAU Registered Member Sports Accident Claim Procedure

AAU Registered Member Sports Accident Claim Procedure AAU Registered Member Sports Accident Claim Procedure AAU members may be eligible for medical expense benefits for treatment of covered injuries sustained while participating in AAU Licensed activities.

More information

PSYCHOLOGICAL HEALTH ASSOCIATES, PA PSYCHOLOGIST-PATIENT SERVICES.

PSYCHOLOGICAL HEALTH ASSOCIATES, PA PSYCHOLOGIST-PATIENT SERVICES. PSYCHOLOGICAL HEALTH ASSOCIATES, PA PSYCHOLOGIST-PATIENT SERVICES. Welcome to my practice. I am happy to have you as a client. This document (the Agreement) contains important information about my professional

More information

WELCOME TO SPORTS CONDITIONING AND REHABILITATION

WELCOME TO SPORTS CONDITIONING AND REHABILITATION WELCOME TO We are pleased you have chosen, (SCAR) for your physical therapy needs. We know there are many choices and we appreciate your confidence in us. You will find we provide unsurpassed individualized

More information

Workers Compensation Program

Workers Compensation Program Workers Compensation Program Colorado Special Districts Property & Liability Pool has created its own workers compensation pool. The special districts now have a more competitive option compared to the

More information

Accident Policy & Procedure

Accident Policy & Procedure Policy Name Related Policies and Legislation Policy Category Relevant Audience Date of Issue / Last Revision Accident Policy & Procedure First Aid Policy Emergency and Critical Incident Management Plan

More information

CRIME VICTIM COMPENSATION APPLICATION

CRIME VICTIM COMPENSATION APPLICATION CRIME VICTIM COMPENSATION APPLICATION Weld County District Attorney s Office Michael J. Rourke -District Attorney Post Office Box 1167 915 Tenth Street Greeley, CO 80632 (970) 356-4010 Fax (970) 336-7224

More information

STYSA Insurance Program & Managing Your Club s Risk. pullenins.com

STYSA Insurance Program & Managing Your Club s Risk. pullenins.com STYSA Insurance Program & Managing Your Club s Risk pullenins.com Types of Policies STYSA Provides General Liability Excess / Umbrella Liability Excess Accident Medical D&O Insurance Does NOT Provide Commercial

More information

Directive. Staff Rule 6.11, Workers' Compensation. Bank Access to Information Policy Designation Public. Catalogue Number. Issued

Directive. Staff Rule 6.11, Workers' Compensation. Bank Access to Information Policy Designation Public. Catalogue Number. Issued Directive Staff Rule 6.11, Workers' Compensation Bank Access to Information Policy Designation Public Catalogue Number Issued Effective October 1, 2011 Retired March 12, 2017 Content Applicable to Issuer

More information

ARTICLES OF INCORPORATION OF BROOKVILLE SOCCER CLUB, INC.

ARTICLES OF INCORPORATION OF BROOKVILLE SOCCER CLUB, INC. ARTICLES OF INCORPORATION OF BROOKVILLE SOCCER CLUB, INC. The undersigned, pursuant to Chapter 10 of Title 13.1 of the Code of Virginia, states as follows: 1.01 Name ARTICLE I NAME The name of the corporation

More information

Facility Reservation & Special Event Procedures

Facility Reservation & Special Event Procedures Facility Reservation & Special Event Procedures Bryanne Knight September 1, 2005 Last Revised: September 15, 2006 Table of Contents 1. Facility Reservation Responsibilities..... 2 2. Facilities Available.......

More information

Sexual Abuse and Molestation. Hired and Non-owned Auto* Directors & Officers Liability* *If yes, please submit Acord forms for these coverages.

Sexual Abuse and Molestation. Hired and Non-owned Auto* Directors & Officers Liability* *If yes, please submit Acord forms for these coverages. Date Prepared: / / General Information Name of Insured Contact Name Title Address City State Zip Mailing Address City State Zip Telephone ( ) Fax ( ) E-mail Address Applicant is: Individual Corporation

More information

NCAA CATASTROPHIC INJURY INSURANCE PROGRAM FREQUENTLY ASKED QUESTIONS

NCAA CATASTROPHIC INJURY INSURANCE PROGRAM FREQUENTLY ASKED QUESTIONS NCAA CATASTROPHIC INJURY INSURANCE PROGRAM FREQUENTLY ASKED QUESTIONS APPLICABLE TO 8/1/17 TO 7/31/2020 POLICY PERIOD This document is a summary of the NCAA Catastrophic Injury Insurance Program. The insurance

More information

ACCESS Therapy Evaluation Appointment Package Checklist

ACCESS Therapy Evaluation Appointment Package Checklist ACCESS Therapy Evaluation Appointment Package Checklist The ACCESS Evaluation and Resource Center provides comprehensive developmental, psychological and psycho-educational diagnoses and rule-outs for

More information

County of Monterey Vehicle Use Policy Revision 02/02

County of Monterey Vehicle Use Policy Revision 02/02 County of Monterey Vehicle Use Policy Revision 02/02 February 5, 2002 FEBRUARY 5, 2002 RETAIN UNTIL SUPERCEDED COUNTY OF MONTEREY VEHICLE USE POLICY & PROCEDURES Table of Contents I) Introduction 1 II)

More information

Trinity Family Physicians

Trinity Family Physicians Trinity Family Physicians Consent and Authorization for Minors By law, a healthcare provider must attempt to contact a birth / custodial parent or legal guardian prior to rendering treatment to a minor

More information

Genesee Valley Bills Youth Football & Cheerleading Organization Registration Form

Genesee Valley Bills Youth Football & Cheerleading Organization Registration Form Genesee Valley Bills Youth Football & Cheerleading Organization Registration Form Participant Information Full Name: First Last Address: Street Address Apartment/Unit # City State ZIP Code Home Phone:

More information

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team

More information

Elite Athlete Strength and Conditioning Camp

Elite Athlete Strength and Conditioning Camp Elite Athlete Strength and Conditioning Camp For your child s safety, and in order to be permitted to participate in all activities, please fill out this form and return it to St. Michael s Summer Camps

More information

RISK MANAGEMENT AND INSURANCE PROGRAM MANUAL (Revised Fall 2017)

RISK MANAGEMENT AND INSURANCE PROGRAM MANUAL (Revised Fall 2017) RISK MANAGEMENT AND INSURANCE PROGRAM MANUAL (Revised Fall 2017) Adapted from the Canadian Snowsports Association (CSA) Risk Management Manual INTRODUCTION... 2 MEMBERSHIP PRACTICES... 4 PROGRAM FACILITIES...

More information

AAD Policy Manual An overview of the Policies, Strategies and Core Operational Guidelines that AAD uses in its Day-to-Day operations.

AAD Policy Manual An overview of the Policies, Strategies and Core Operational Guidelines that AAD uses in its Day-to-Day operations. AAD Policy Manual 2015-16 2018-19 An overview of the Policies, Strategies and Core Operational Guidelines that AAD uses in its Day-to-Day operations. -Table of Contents- AAD General Policy Pages 3-8 AAD

More information

NEWARK PUBLIC SCHOOL ATHLETICS PERMISSION & EMERGENCY INFORMATION FORM (ALL LINES MUST BE FILLED OUT COMPLETELY IN INK)

NEWARK PUBLIC SCHOOL ATHLETICS PERMISSION & EMERGENCY INFORMATION FORM (ALL LINES MUST BE FILLED OUT COMPLETELY IN INK) NEWARK PUBLIC SCHOOL ATHLETICS PERMISSION & EMERGENCY INFORMATION FORM (ALL LINES MUST BE FILLED OUT COMPLETELY IN INK) LAST NAME, FIRST NAME, MI BIRTHDATE AGE SEX SPORT(S) GRADE HOMEROOM# & TEACHER STUDENT

More information

Accident Benefits Claim Instructions

Accident Benefits Claim Instructions Claim Instructions Your Accident Benefit Claim This packet contains the forms necessary to apply for. Every space on these forms should be filled in to avoid delay in processing your application. If a

More information

DSN. CAMP [ERS] THINKING CREATIVELY

DSN. CAMP [ERS] THINKING CREATIVELY THINKING CREATIVELY DESIGN DSN. CAMP [ERS] March 1, 2016 Dear Participant, We are looking forward to your participation in the Thinking Creatively Design Camp! The program will take place at Kean University,

More information

Overview: of National Interscholastic Cycling Association (NICA) Insurance Policy

Overview: of National Interscholastic Cycling Association (NICA) Insurance Policy NICA/Leagues & Teams Commercial General Liability Includes coverage for the day-to-day operations of the Association/League and its teams including meetings, team practice rides (including team skills

More information

ACCIDENT INSURANCE PROTECTION HELPING PROVIDE:

ACCIDENT INSURANCE PROTECTION HELPING PROVIDE: 2018 19 MICHIGAN STUDENT ACCIDENT INSURANCE PROGRAM Multi Benefit Protection Administered by: 5071 West H Avenue Kalamazoo, MI 49009 8501 Phone: (269) 81 660 Fax: (269) 492 0084 www.1stagency.com ACCIDENT

More information

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE:

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Spring Break Camp PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Have you attended Camp C-Woo before? Yes No CWU ID Number Spring

More information

Authorization to Release Health Information

Authorization to Release Health Information Authorization to Release Health Information Patient Information: Name of Patient Date of Birth Address City, State, Zip Phone At my request, may release the following information: (Name of the entity)

More information

Townsend ASHBY YOUTH BASEBALL AND SOFTBALL VOLUNTEER APPLICATION PACKAGE

Townsend ASHBY YOUTH BASEBALL AND SOFTBALL VOLUNTEER APPLICATION PACKAGE Townsend ASHBY YOUTH BASEBALL AND SOFTBALL VOLUNTEER APPLICATION PACKAGE VERSION 5.0 UPDATED 02/10/2019 TAYBS Volunteer Application Thank you for your offering your time to volunteer with the Townsend

More information

HIPAA NOTICE OF PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about this notice,

More information

BIG ROCK GYMNASTICS & DYNAMITE CHEER

BIG ROCK GYMNASTICS & DYNAMITE CHEER BIG ROCK GYMNASTICS & DYNAMITE CHEER Registration Form Please Print Clearly PERSONAL INFORMATION: Mailing Address City St Zip Both Parents E-Mail Address: / Home Phone # Childs Cell # Childs Email Mothers

More information

Greater South Showcase Lacrosse Tournament

Greater South Showcase Lacrosse Tournament Greater South Showcase Lacrosse Tournament Risk Management Policy Statement: It is the policy of the Greater South Showcase Tournament that all of the tournament directors and volunteers shall comply with

More information

Purpose To provide clear standards and guidelines for allocating use of City of Goodyear and associated school districts athletic fields/facilities.

Purpose To provide clear standards and guidelines for allocating use of City of Goodyear and associated school districts athletic fields/facilities. ATHLETIC FACILITY/FIELD USE AND ALLOCATION POLICY RULES & REGULATIONS Purpose To provide clear standards and guidelines for allocating use of City of Goodyear and associated school districts athletic fields/facilities.

More information

INDEPENDENCE BLUE CROSS LONG TERM CARE PROGRAM NOTICE OF PRIVACY PRACTICES

INDEPENDENCE BLUE CROSS LONG TERM CARE PROGRAM NOTICE OF PRIVACY PRACTICES INDEPENDENCE BLUE CROSS LONG TERM CARE PROGRAM NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

More information

Student Accident Insurance Plans

Student Accident Insurance Plans 2017 2018 Student Accident Insurance Plans K 12 Student Accident Insurance Plans Why you need Student Insurance... Your school does not provide medical insurance to cover injuries to students. Instead,

More information

RISK MANAGEMENT (RM) DEFINITIONS. Board: All references to the Board mean the Board of Directors of Washington Youth Soccer.

RISK MANAGEMENT (RM) DEFINITIONS. Board: All references to the Board mean the Board of Directors of Washington Youth Soccer. DEFINITIONS Established Verifiable Provider: For purposes of the, an established verifiable provider includes, but is not limited to: United States Postal Service certified mail, return receipt requested;

More information

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone: Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player

More information

PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT

PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT PALOS VERDES PENINSULA UNIFIED SCHOOL DISTRICT High School Independent Study Physical Education (ISPE) Checklist The following documents must be completed and submitted to your student s counselor for

More information

School Accident Program Parent/Guardian Guide Program 3

School Accident Program Parent/Guardian Guide Program 3 School Accident Program Parent/Guardian Guide Program 3 A nonprofit independent licensee of the BlueCross BlueShield Association Dear Parent or Guardian: This packet contains important documents regarding

More information

University of Arkansas - Fort Smith Department of Intercollegiate Athletics Medical Bill Payment Policies and Procedures

University of Arkansas - Fort Smith Department of Intercollegiate Athletics Medical Bill Payment Policies and Procedures University of Arkansas - Fort Smith Department of Intercollegiate Athletics Medical Bill Payment Policies and Procedures Section I: Health Insurance Coverage/ Permissible Medical Expenses 1. University

More information

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:

Registration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer: Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,

More information

FACILITY USE AGREEMENT BETWEEN CITY OF OTHELLO AND OTHELLO BARRACUDAS SWIM TEAM

FACILITY USE AGREEMENT BETWEEN CITY OF OTHELLO AND OTHELLO BARRACUDAS SWIM TEAM BETWEEN CITY OF OTHELLO AND OTHELLO BARRACUDAS SWIM TEAM This Agreement is made this Monday, the 23rd of March, 2015, by and between the CITY OF OTHELLO ("CITY") and the OTHELLO BARRACUDAS SWIM TEAM ("USER"),

More information

Sexual Abuse and Molestation. Hired and Non-owned Auto* Directors & Officers Liability* *If yes, please submit Acord forms for these coverages.

Sexual Abuse and Molestation. Hired and Non-owned Auto* Directors & Officers Liability* *If yes, please submit Acord forms for these coverages. Date Prepared: / / General Information Name of Insured Contact Name Title Address City State Zip Mailing Address City State Zip Telephone ( ) Fax ( ) E-mail Address Applicant is: Individual Corporation

More information

2. Policy. The general policies of the University regarding employee benefits are as follows:

2. Policy. The general policies of the University regarding employee benefits are as follows: 40-8 Employee Benefits 40-8-1 Purpose 40-8-2 Policy 40-8-3 Administration 40-8-4 Insurance Benefits 40-8-5 Retirement 40-8-6 Workers' Compensation 40-8-7 Unemployment Compensation 40-8-8 Tax-Deferred Annuities

More information

Baseball Softball T-ball. Baseball/Softball/T-ball Accident Insurance

Baseball Softball T-ball. Baseball/Softball/T-ball Accident Insurance Baseball Softball T-ball Baseball/Softball/T-ball Accident Insurance Baseball/Softball/T-ball Accident Insurance Who is Covered All players, coaches, managers, and volunteers of the teams specified in

More information

Comprehensive, Multi-Disciplinary Assessments

Comprehensive, Multi-Disciplinary Assessments ACCESS Therapy Evaluations Admissions: Beth Rice, M.A. Contact Info: Office: 501-217-8600 Email: beth@accessgroupinc.org Fax: 501-217-8636 Comprehensive, Multi-Disciplinary Assessments General Information

More information

REQUEST FOR PROPOSAL CONCESSION OPERATIONS. for. The City of Sherman, Texas

REQUEST FOR PROPOSAL CONCESSION OPERATIONS. for. The City of Sherman, Texas REQUEST FOR PROPOSAL CONCESSION OPERATIONS for The City of Sherman, Texas Prepared By: City of Sherman Finance Department 405 N. Rusk St. P.O. Box 1106 Sherman, Texas 75091-1106 Craig Long Budget Analyst

More information

APPLICATION FOR HOPE FUND ASSISTANCE PROGRAM GUIDELINES AND CRITERIA

APPLICATION FOR HOPE FUND ASSISTANCE PROGRAM GUIDELINES AND CRITERIA APPLICATION FOR HOPE FUND ASSISTANCE PROGRAM GUIDELINES AND CRITERIA PROGRAM OBJECTIVE: HOPE stands for Helping Our Peers in Emergency. It is a crisis fund supported by Scripps employees for Scripps employees.

More information

NATIONAL INSURANCE SCHEME SUMMARY BENEFITS & CLAIMS PROCEDURES

NATIONAL INSURANCE SCHEME SUMMARY BENEFITS & CLAIMS PROCEDURES NATIONAL INSURANCE SCHEME SUMMARY BENEFITS & CLAIMS PROCEDURES 2016-2017 VERSION CONTROL REGISTER MATERIAL TITLE: Touch Football Australia National Insurance Scheme: Summary Benefits & Claims Procedures

More information

EFFECTIVE DATE OF THIS NOTICE: 8/5/09

EFFECTIVE DATE OF THIS NOTICE: 8/5/09 NOTICE OF PRIVACY PRACTICES EFFECTIVE DATE OF THIS NOTICE: 8/5/09 THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

US Lacrosse Event Insurance Plans: For Camps, Clinics & Alumni/ Exhibition Games

US Lacrosse Event Insurance Plans: For Camps, Clinics & Alumni/ Exhibition Games US Lacrosse Event Insurance Plans: For Camps, Clinics & Alumni/ Exhibition Games Event Insurance Plans The US Lacrosse Camp, Clinic & Alumni/Exhibition Game Insurance Programs provide blanket insurance

More information

MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM

MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM Camp Information Address: City, State, Zip Code: Gender: Medical Information The decision whether to permit the participant identified

More information

General Field Request Form (All Sports)

General Field Request Form (All Sports) General Field Request Form (All Sports) This request is for: Youth Adult Spring Season Fall Season (please complete one request form per season) I. Name of Requesting Organization Name of Organization

More information

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY

Individual Waiver. PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY PUEBLO RANGERS Individual Waiver Soccer Club PUEBLO RANGERS, 5v5 or 3v3 SOCCER LEAGUE AND TOURNAMENT WAIVER AND RELEASE OF LIABILITY (MUST BE COMPLETED AND PRESENTED AT LEAST 30 MINUTES PRIOR TO YOUR FIRST

More information

In addition there are several aspects of your disability claim that you should be aware of:

In addition there are several aspects of your disability claim that you should be aware of: Dear Colleague: American Airlines has partnered with Harvey Watt and Company as the Claim Administrator for the Pilot Long Term Disability Plan (the Plan). We have enclosed the Claim Application along

More information