2017 INTERMEDIATE STAIR STEP APPLICATION FORM
85 Scarsdale Rd., Suite 301, Toronto, Ontario M3B 2R2
Tel: (416) 426-7150 Fax: (416) 426-7150
Please read the instructions carefully. Be sure to fill out the appropriate sections.
Please submit completed application along with payment to the Softball Ontario office.
Eligibility: Must be under 19 years of age and have taken an Intermediate Clinic or passed the Intermediate Take Home exam in 2016. If you are
interested, please tear off and send this application form along with the appropriate fee.
The deadline to register and send your exam into the Softball Ontario office is August 31, 2017.
UMPIRE DATA (This section must be completed by all umpires.)
Last Name:
First Name:
Slo-Pitch Zone:
Fast Pitch Zone:
Date of Birth (MM/DD/YY)
/
/
Gender: M
F
To check what Zone you are in, visit www.softballontario.ca!
Apt./Unit:
Street Address:
Province:
City:
Phone – Home: (
)
Work: (
Postal Code:
)
Cell: (
Email:
)
Are you designated as a Local Umpire-in-Chief? Yes
Phone – Home: (
Name of local umpire-in-chief/assignor:
Name of local umpire association:
No
)
Local UIC email:
Which Year Did You Start Umpiring?
Fast Pitch Year:
Would like an on-field evaluation completed?
No
Yes
Slo-Pitch Year:
If yes,
FP
or
SP
or
Both
EXAM PRICE
FP Only
$27.00 ($23.89 + $3.11 HST)
FREE
No Charge – Canada Post (Please allow 1-2 weeks to receive your package)
SHIPPING
Standard
IMPORTANT NOTE: An umpire is only insured in the game in which he/she is registered (e.g. if an umpire registers for fast pitch only, he/she is
only insured in fast pitch). An umpire must register in both games in order to be insured in both games. Paying the stair step fee entitles an
umpire to being insured for fast pitch only. To obtain insurance coverage for slo-pitch games, please contact the office for information on this
option/upgrade.
Payment, Registration Period and Processing Time Options: (Must choose ONE )
Note: Cheques or Money Orders to be made payable to SOFTBALL ONTARIO (HST No. BN #12602 1195)
Option A:
i)
Payment by Certified Cheque, Money Order, Cash, VISA, Master Card or Amex
Registration and insurance coverage commences immediately upon receipt of correct fee and application and is valid until March
31, 2018.
Method of Payment:
Card No.
Money Order
Certified Cheque
Expiry Date:
Cash
/
Credit Card (Visa, MC, AMEX accepted)
Signature:
i)
Payment by Regular (Personal) Cheque - Two (2) Week Waiting Period for Processing**. (Note: Postdated Cheques Are Not Accepted.)
Umpire package is processed two (2) weeks after receipt of correct fee and application. Please note: if paying by regular cheque and you
choose the courier service, the two-week waiting period is still in effect, i.e. your package goes in the express post two weeks after receipt
of correct fee and application.
ii)
Registration and insurance coverage commences two (2) weeks after receipt of correct fee and application and is valid until March
31, 2018.
Option B:
NOTE: * Processing is defined as the day the Umpire Package goes into the mail system*
** N.S.F. or Returned Cheques will be charged a $25.00 fee to cover the bank charges and the staff’s time. All applications rejected due to a N.S.F. cheque or a
returned cheque will not be eligible for affiliations until the $25.00 fee is paid along with the registration fee in the form of a certified cheque or money order. Further, all
rejected applicants will be placed on Softball Ontario "Not in Good Standing List" and will not be eligible to officiate in Ontario until the outstanding amount is cleared
up.
ACCEPTANCE OF TERMS AND CONDITIONS (Please read the back of this form before signing below)
I have read and agree to abide by the terms and conditions included on the back of this form.
Signature
Date:
TRANSFERS or REFUND of Umpire Exam Packages are NOT Permitted.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
1.
This is a binding legal agreement; therefore clarify any questions or concerns before signing. In consideration of being allowed to participate in any way in Softball Ontario
Programs and tournaments, related events and activities (collectively the “Activities”), the undersigned acknowledges and agrees that:
Disclaimer
2.
Softball Ontario and its directors, officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and
lessors of premises used to conduct the event (collectively Softball Ontario) are not responsible for any injury, personal injury, damage, property damage, expense, loss of
income or loss of any kind suffered by the undersigned during, or as a result of, the Activities, caused in any manner whatsoever including, but not limited to, the negligence
of Softball Ontario.
I have read and agree to be bound by paragraphs 1 and 2.
Description of Risks
3.
I am participating voluntarily in the Activities. In consideration of my participation, I hereby acknowledge that I am aware of the risks, dangers and hazards associated with or
related to the Activities. The risks, dangers and hazards include, but are not limited to, injuries from:
a)
Executing strenuous and demanding physical techniques;
b)
Vigorous physical exertion, strenuous cardiovascular workouts and rapid movements;
c)
Exerting and stretching various muscle groups;
d)
Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
e)
Contact, colliding, falling or being struck by other participants or equipment;
f)
Grass, turf and other surfaces including bacterial infections and rashes;
g)
Collisions with fences, poles, stands and softball equipment;
h)
Spinal cord injuries which may render me permanently paralyzed;
i)
Extreme weather conditions which may result in heatstroke, sunstroke or hypothermia; and
j)
Travel to and from competitive events and associated non-competitive events which are an integral part of the Activities.
4.
Furthermore, I am aware that my risk of injury is reduced if I follow all rules established for participation; and that my risk of injury increases as I become fatigued.
Release of Liability and Disclaimer
5.
In consideration of Softball Ontario allowing me to participate, I agree:
a)
That my physical condition has been verified by a physician to participate;
b)
The sole responsibility for my safety remains with me;
c)
To remove myself if I sense or observe any unusual hazard or unsafe condition; or feel unable or unfit to safely continue;
d)
To ASSUME all risks arising out of, associated with or related to my participation;
e)
To WAIVE any and all claims that I may have now or in the future against Softball Ontario;
f)
To knowingly and freely ACCEPT AND FULLY ASSUME all such risks, both known and unknown, and possibility of personal injury, death, property damage, expense
and related loss, including loss of income, resulting from my participation in the activities, events and programs of Softball Ontario; and
g)
To FOREVER RELEASE Softball Ontario from any and all liability for any and all claims, demands, actions, damages (including direct, indirect, special and/or
consequential), losses, actions, judgments, and costs (including legal fees) (collectively, the “Claims”) which I may have or may in the future, that might arise out of,
result from, or relate to my participation in the Activities, even though such Claims may have been caused by any manner whatsoever, including but not limited to, the
negligence, gross negligence, negligent rescue, omissions, carelessness, breach of contract and/or breach of any statutory duty of care of Softball Ontario.
I have read and agree to be bound by paragraphs 3 - 5.
Acknowledgement
6.
I acknowledge that I have read and understand this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding upon
myself, my heirs, spouse, children, parents, guardians, next of kin, executors, administrators and legal or personal representatives.
7.
By signing, typing in your name below and clicking the “I Agree” icon, you agree to be bound this Legal Agreement.
I AGREE
Name of Participant (Please Print)
Date
CONSENT FOR USE OF PERSONAL INFORMATION AND PHOTO RELEASE
1.
By providing Softball Ontario with your personal information on this registration form, you are giving express consent to Softball Ontario to collect and use your personal
information for the following purposes: receiving communications and commercial communications from Softball Ontario and Softball Canada, ensuring that umpires officiate
in the appropriate age groups and for processing registration and clinic fees. Personal Information is also disclosed to Softball Ontario, Softball Canada and Member
Associations’ volunteers to place and communicate with umpires. This consent is in compliance with the Personal Information Protection and Electronic Documents Act and
the Canadian Anti-Spam Legislation.
2.
I understand that I may withdraw such consent at any time by contacting Softball Ontario’s Privacy Officer. The Privacy Officer will advise the implications of such
withdrawal.
3.
I also understand that Softball Ontario has the right to take photographs, videotape, or digital recordings of me and to use these in any and all media.
By checking here, you agree to abide by the terms and conditions included in the consent for use of personal information and photo release.
ACCEPTANCE OF TERMS AND CONDITIONS
1.
In consideration of the acceptance of my participation, I agree as follows:
a)
b)
c)
d)
To abide by the bylaws, policies, rules and regulations of Softball Ontario (“Governing Documents”), including, but not limited to its Policy Relating to Member Conduct.
Failure to adhere to the Softball Ontario Governing Documents may result in disciplinary sanctions.
Copy of Softball Ontario Governing Documents can be found on its web page: www.softballontario.ca
I accept sole responsibility for my personal possessions and equipment.
By typing in your name and the date below and clicking the “I Agree” icon, you and/or your child/ward agree to be bound by these terms and conditions.
By checking here, you agree to abide by the terms and conditions included in the Acceptance of Terms and Conditions.
Name of Participant (Please Print)
Date