KANNAPOLIS PARKS & RECREATION - 401 LAUREATE WAY, KANNAPOLIS, NC 28081
WWW.KANNAPOLISNC.GOV 704-920-4343
Youth Registration Form
PLAYER NAME
FIRST NAME MIDDLE NAME LAST NAME
PARENT/GUARDIAN
ADDRESS
MAILING ADDRESS PHYSICAL ADDRESS (if different)
CITY STATE ZIP CODE
TELEPHONE
MOBILE HOME WORK
EMAIL
DATE OF BIRTH ____________________ AGE ____________________ MALE FEMALE
DIVISION (AGE AS OF 2/1/2020) JERSEY SIZE
INSTRUCTIONAL 3-4 COED 5-6 YOUTH SMALL □ ADULT MEDIUM
COED 7-8 COED 9-10 □ YOUTH MEDIUM □ ADULT LARGE
COED 11-12 COED 13-15 □ YOUTH LARGE □ ADULT XL
ADULT SMALL □ ADULT XXL
IS THERE A SPECIFIC DAY OF THE WEEK (MON-THURS) YOUR CHILD CANNOT ATTEND PRACTICE? ____________________
IF YES, WHAT DAY? □MONDAY □TUESDAY □WEDNESDAY □THURSDAY
*We cannot make any guarantees, but we will do all we can to accomadate your practice night conflicts*
OUR PROGRAMS ARE DEPENDENT UPON VOLUNTEER COACHES. ARE YOU AS A PARENT WILLING TO HELP COACH A TEAM IF
NEEDED? □ YES □ NO □ MAYBE
EMERGENCY CONTACT: _______________________________________________________________________________________
*Other than contact listed above* NAME RELATION PHONE
WHAT SCHOOL DOES YOUR CHILD ATTEND? ______________________________________________________________________
PLEASE LIST ANY REASON WHY IT WOULD BE DIFFICULT FOR YOUR CHILD TO PARTICIPATE:
____________________________________________________________________________________________________________
HOW DID YOU HEAR ABOUT US? ________________________________________________________________________________
REGISTRATION FEE:
□ CITY OF KANNAPOLIS RESIDENT ($40.00 REGISTRATION FEE)
□ NON RESIDENT ($60.00 REGISTRATION FEE)
PLEASE MAKE CHECKS PAYABLE TO: CITY OF KANNAPOLIS
KANNAPOLIS PARKS & RECREATION - 401 LAUREATE WAY, KANNAPOLIS, NC 28081
WWW.KANNAPOLISNC.GOV 704-920-4343
Youth Registration Form
PARENTAL CONSENT INFORMATION: MUST BE SIGNED FOR APPLICANT TO PARTICIPATE.
I (OR MY CHILD/REN) AM VOLUNTARILY PARTICIPATING IN THE PROGRAM ABOVE. IN RETURN FOR THE OPPORTUNITY TO PARTICIPATE,
I VOLUNTARILY FOR MYSELF (OR CHILD/REN) WAIVE, RELEASE, INDEMNIFY AND HOLD HARMLESS THE CITY OF KANNAPOLIS, ITS
EMPLOYEES, AND CONTRACTORS FROM ANY LIABILITIES, CLAIMS, DAMAGES, INJURIES, LOSSES, AND EXPENSES INCLUDING
REASONABLE ATTORNEY FEES AND COSTS WHATSOEVER, INCLUDING THOSE FOR PERSONAL INJURY, DEATH, OR PROPERTY DAMAGE,
WHICH MAY ARISE FROM OR IN CONNECTION WITH PARTICIPATION IN THIS PROGRAM, CLASS OR EVENT.
I HEREBY GIVE TO THE CITY OF KANNAPOLIS CONSENT FOR EMERGENCY TREATMENT AND TRANSPORTATION OF MY MINOR CHILD FOR
ANY CONDITION THAT MAY ARISE FROM OR IN CONNECTION WITH PARTICIPATION IN THE PROGRAM, CLASS OR EVENT AND I SHALL BE
RESPONSBILE FOR THE PAYMENT OF ALL COSTS ASSOCIATED WITH SUCH EMERGENCY TREATMENT OR TRANSPORTATION. AND I
HEREBY GIVE PERMISSION FOR THE INFORMATION ABOVE TO BE RELEASED TO EMERGENCY PERSONNEL.
FURTHERMORE, I HEREBY GIVE PERMISSION TO THE CITY OF KANNAPOLIS TO USE ANY PHOTOGRAPHS OR VIDEO RECORDINGS TAKEN
BY THE CITY OF KANNAPOLIS, ITS OFFICERS, EMPLOYEES OR AGENTS OF EITHER ME OR MY CHILD/REN, DURING PARTICIPATION IN THIS
PROGRAM, CLASS OR EVENT TO BE USED AT THE DISCRETION OF THE DEPARTMENT. I AGREE SUCH PHOTOGRAPHS SHALL BE THE
PROPERTY OF THE CITY OF KANNAPOLIS AND I AM NOT ENTITLED TO COMPENSATION OF ANY KIND FOR USE OF SUCH PHOTOGRAPHS.
PARENTS’ CODE OF ETHICS: I HEREBY PLEDGE TO PROVIDE POSITIVE SUPPORT, CARE, AND ENCOURAGEMENT FOR MY CHILD
PARTICIPATING IN YOUTH SPORTS BY FOLLOWING THIS PAYS PARENTS’ CODE OF ETHICS: I WILL ENCOURAGE GOOD SPORTSMANSHIP BY
DEMONSTRATING POSITIVE SUPPORT FOR ALL PLAYERS, COACHES, AND OFFICIALS AT EVERY GAME, PRACTICE, OR OTHER YOUTH SPORTS
EVENT. I WILL PLACE THE EMOTIONAL AND PHYSICAL WELL-BEING OF MY CHILD AHEAD OF A PERSONAL DESIRE TO WIN. I WILL INSIST
THAT MY CHILD PLAY IN A SAFE AND HEALTHY ENVIRONMENT. I WILL REQUIRE THAT MY CHILD’S COACH BE TRAINED IN THE
RESPONSIBILITIES OF BEING A YOUTH SPORTS COACH AND THAT THE COACH UPHOLDS THE COACHES’ CODE OF ETHICS. I WILL SUPPORT
COACHES AND OFFICIALS WORKING WITH MY CHILD, IN ORDER TO ENCOURAGE A POSITIVE AND ENJOYABLE EXPERIENCE FOR ALL. I WILL
DEMAND A SPORTS ENVIRONMENT FOR MY CHILD THAT IS FREE FROM DRUGS, TOBACCO, AND ALCOHOL, AND WILL REFRAIN FROM
THEIR USE AT ALL YOUTH SPORTS EVENTS. I WILL REMEMBER THAT THE GAME IS FOR YOUTH - NOT FOR ADULTS. I WILL DO MY VERY
BEST TO MAKE YOUTH SPORTS FUN FOR MY CHILD. I WILL HELP MY CHILD ENJOY THE YOUTH SPORTS EXPERIENCE BY DOING WHATEVER
I CAN, SUCH AS BEING A RESPECTFUL FAN, ASSISTING WITH COACHING, OR PROVIDING TRANSPORTATION. I WILL ASK MY CHILD TO TREAT
OTHER PLAYERS, COACHES, FANS, AND OFFICIALS WITH RESPECT REGARDLESS OF RACE, SEX, CREED OR ABILITY.
____________________________________________________________________________________________________________
SIGNATURE OF PARENT/ GUARDIAN PRINTED NAME OF PARENT/ GUARDIAN DATE
SPECIAL REQUESTS:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
PLEASE NOTE THAT ALL REQUESTS CANNOT BE HONORED, BUT WE WILL ATTEMPT TO HONOR YOUR REQUESTS IF FEASIBLE. THE
ROSTERS WILL BE LOCKED AFTER THE DRAFT IS COMPLETE. NO SWITCHING TEAMS AFTER THE DRAFT IS COMPLETE.
FOR OFFICE USE ONLY:
CASH / CHECK#______________ AMOUNT $______________ DATE______________
BIRTH CERTIFICATE ON FILE______________ NOTES :
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