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 #: Birthday: Age: On Dec 31 st Age Group (Circle One) 10U 12U 14U 16U 18U PAID: Mother s/guardian Name: Address: Home Phone: City: State: Zip: Cell Phone: Father s/guardian Name: Address: Home Phone: City: State: Zip: Cell Phone: Athlete Information Last team played for: Positions (in order of those you play most often): Are you willing to play other positions: Yes/No. What Positions? Years of travel ball and organizations: Team name, years, and positions: 10U 12U 14U 16U 18U AZ-Scorpions Registration Form 1 of 6 1 May 2014
Name: Do you play another fall sport? What sport? Throw: Right / Left Hit: Right / Left / Both Slap: Yes / No List private instructors: Hitting Day/Time Pitching Day/Time Catching Day/Time Memorandum of Understanding I hereby acknowledge that I have been informed of the program requirements and agree to follow through with each commitment. (Parent/Guardian - Please initial each item listed.) Financial commitment will be met. Financial Commitment to the AZ-SCORPIONS. Paid: $330. Will receive 3 uniforms, (1 w/name), pants and shorts, Helmet, Cleats. All money paid, donated, or raised for the AZ-SCORPIONS is non-refundable. I understand since dues are not paid to the AZ-SCORPIONS various fundraisers will take place in order to raise the money. I understand and agree that this will not be a free ride and I will do my part, above and beyond, and participate in all fundraising activities that are put on by the AZ-SCORPIONS. I have read and signed the AZ-SCORPIONS Consent for Treatment and Release of Liability form. I have read and signed the AZ-SCORPIONS Informed Consent form. I understand that all athletes are required to purchase individual insurance. I understand the financial commitment does not guarantee playing time for my athlete. Additionally, my initial indicates that a "Verbal Promise" of playing time, preferred position, or any other gifts were not promised to my family or athlete as a consideration in electing to play ball for the AZ-SCORPIONS. I understand that team assignments are final, and that athletes may not be assigned to the same teams as their friends, schoolmates, or even those in their own age bracket. Since girls develop, strengthen and grow at different rates, their assignments may change from year to year. Additionally athletes may be asked to move up or down an age bracket because of the athletes skill level, or to balance teams. I give my consent for my athlete to be photographed or filmed while participating in AZ-SCORPIONS activities and for the resulting images or videos to be used by AZ-SCORPIONS for promotional purposes. Parent Name(s) (please print) Parent Signature(s) AZ-Scorpions Registration Form 2 of 6 1 May 2014
CONSENT FOR TREATMENT OF MINORS AND RELEASE OF LIABILITY PLAYER: DATE OF BIRTH PARENT/GUARDIAN: TELEPHONE NO. ADDRESS: STREET ADDRESS CITY STATE ZIP Person to notify in case of emergency (other than parent/guardian): NAME: RELATIONSHIP TO PLAYER: HOME PHONE: CHILD'S PHYSICIAN: PHONE: DENTIST: PHONE: ALLERGIES (IF ANY): CURRENT MEDICATION (IF ANY): LAST TETANUS IMMUNIZATION: MEDICAL INSURANCE PROVIDER: GROUP OR PLAN NO.: The undersigned, the parent(s) or legal guardian(s) of the above-named minor, hereby authorize my child s coach or any other official of the Arizona Scorpions to consent to any medical examination or treatment, including hospitalization and/or surgery, which is deemed advisable, appropriate or necessary by any duly licensed physician, emergency medical technician, paramedic or other medical practitioner in order to properly care for my child in the event she sustains injury or is suffering from any illness during the course of any playing or non-playing activities of the Arizona Scorpions; provided, however, the foregoing consent or authorization shall be valid only in a situation where a parent or legal guardian of the above-named minor is not reasonably available to provide the necessary consent to medical treatment. I also give my permission for my child to represent the Arizona Scorpions, a competitive fast pitch softball team, and to accompany her team to any of its local or out of town tournaments, games or practices. In the event my child is injured or becomes ill during the course of any playing or non-playing activities of the Arizona Scorpions, I hereby authorize her coach or any other official of the AZ-Scorpions Registration Form 3 of 6 1 May 2014
Name: Arizona Scorpions to administer or obtain appropriate first aid and, if necessary, to transport my child to a physician or hospital for further treatment. I hereby consent to my child s participation in any and all activities of the Arizona Scorpions, and I agree to release, indemnify and hold harmless the Arizona Scorpio ns and its officers, directors and agents, from and against any liability of any kind arising out of the activities of the Arizona Scorpions or transportation to and from such activities. I understand that the medical insurance provided by the Arizona Scorpions affords only excess or secondary coverage which would apply only after other medical insurance providing coverage for my child has been resorted to. I further understand that the coverage provided by the Arizona Scorpions may have a deductible amount. I understand that participation in competitive athletics involves risk of physical injury or death which cannot be totally eliminated. However, players may reduce such risk by following a proper conditioning program, wearing or using helmets and other appropriate safety equipment, and properly reporting any injury to their coaches. In allowing my child to participate in the activities of the Arizona Scorpions, I understand that we are expressly assuming the risks referred to above and releasing the Arizona Scorpions from any and all liability arising out of or in any related to the activities giving rise to such risks. Signature of Parent(s)/Guardian(s) Signature of Players AZ-Scorpions Registration Form 4 of 6 1 May 2014
Parent Code of Conduct The Arizona Scorpions Organization promotes good sportsmanship on behalf of all players, parents, coaches and board members. Failure to abide by the policies set forth in this document may result in the loss of playing time for the player, or in extreme cases removal of the player from the team. As a parent of a member of an Arizona Scorpions Organization: 1. I acknowledge that I am representing the Arizona Scorpions Organization at all times. I will refrain from using profanity, displaying a negative attitude, or exhibiting poor sportsmanship at any time. I am also representing my daughter at Arizona Scorpions Organization events, and agree to do so in a positive manner. 2. I will treat all Arizona Scorpions Organization team members, coaches, and parents, as well as opposing players, coaches, spectators and umpires with respect. 3. I will show support for all Arizona Scorpions Organization teams during competition in a positive manner. 4. I will always display a positive, team-oriented attitude during Arizona Scorpions Organization events. I will support the decisions of the coaching staff at all times, and will refrain from contradicting or negating a coaching decision. If I have any questions and/or concerns about the well-being of the team, my daughter and I will maturely and privately approach the coach or parent representative with my concerns. 5. I will not coach my daughter or her teammates from the sidelines at any time, in practices or games. I will leave this responsibility to the coaching staff. I will make sure that my daughter is prompt and ready to participate in all practices, games and/or team meetings. This means my daughter will arrive early enough to the practice or game so that she is ready to begin at the designated time - and not just arriving or putting on equipment. If I foresee a potential conflict with practice, games, and/or team meetings, I will make every attempt possible to contact the coaches in advance. 6. I will try to schedule my daughter s appointments, vacations, other camps, etc. around practice time, games, and/or team meetings. If my daughter does have to miss a team function, I will notify the coach well in advance of her absence. I acknowledge that extended or unexcused absence may result in a decrease or loss in playing time for my daughter. 7. I will support my daughter and her team by attending as many tournaments as possible, and demonstrating positive sportsmanship while in attendance. I acknowledge that I have a responsibility to Arizona Scorpions Organization at home tournaments for working and/or insuring the event is a success. 8. I have read and agree to adhere to the above responsibilities. By signing below, I agree to abide by the stated expectations and policies while affiliated with an Arizona Scorpions Organization team. Parent Name(s) (please print) Parent Signature(s) AZ-Scorpions Registration Form 5 of 6 1 May 2014
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT ("AGREEMENT") IN CONSIDERATION of being permitted to participate in any way in any AZ-Scorpions activity ("Activity") at any time during the current calendar year I, for myself, my personal representatives, assigns, heirs, and next of kin: 1. ACKNOWLEDGE, agree and represent that I understand the nature of Softball Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe the conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. FULLY UNDERSTAND that: (a) SOFTBALL ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("Risks"); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity. 3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the ARIZONA SCORPIONS ORGANIZATION, its administrators, directors, agents, officers, members, volunteers, team members, and employees, other participants, any sponsors, advertisers, and, if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the RELEASEES herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. PRINTED NAME OF PARTICIPANT: PHONE: ADDRES: (Street) (City) (State) (Zip) PARTICIPANT'S SIGNATURE: DATE: Below section must be completed by Parent/Guardian for any participant under the age of 18. MINOR RELEASE AND I, THE MINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF SOFTBALL ACTIVITIES AND THE MINOR'S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE'S FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR'S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIMS AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR ANY COST THAT MAY OCCUR AS A RESULT OF ANY SUCH CLAIM. PRINTED NAME OF PARENT/GUARDIAN: PHONE: ADDRES: (Street) (City) (State) (Zip) PARENT/GUARDIAN SIGNATURE (if participant is under age of 18): DATE: AZ-Scorpions Registration Form 6 of 6 1 May 2014