For Office Staff Only:
Date Pd: ____________
Amount:___________
Payment type: $ / CC / CHK
This document contains information which must be protected IAW AFI 33-332 and DOD regulation 5400.11;
Privacy Act of 1974 as Amended Applies.
HOLLOMAN AFB YOUTH SPORTS REGISTRATION
Sport:____________________________________________________________
Name of child:_____________________________________________________ Sex: M / F
Age:__________ School Grade:________ D.O.B.________________ Jersey Size:_______
Sponsor Name:___________________________________
Home Phone:________________________
Rank:__________
Alternate Phone:________________________
Email Address: (Please PRINT CLEARLY and list email(s) you would like season information to go to:
_________________________________________________________________________________
Interested in Coaching: _________
Preferred Practice Days (see note 2):_________________________
Allergies/ Illness/Medical Issues:____________________________________________________________
Emergency Contact: Name: _________________________________ Phone: __________________
As the parent or legal guardian of the child named above, I understand and agree to the following terms of
registration and participation:
1.
2.
3.
4.
5.
Teams will be organized based upon availability of volunteer coaches.
Requested practice days are not guaranteed.
Age groupings may change based on the number of children registering.
Registration does not guarantee placement.
Refunds will only be made in the event that the child cannot be placed on a team, for unexpected PCS,
documented medical conditions and short or long term emergency leave. Request for a refund will be
made before the 1st game of the sport season. Once the refund request is made the parent/guardian
has two weeks to claim the refund, after that two week period refund will not be granted.
6. A Sports Physical & Immunization Record is required at the time of registration.
7. All players and parents will show good sportsmanship both on and off the court/field during all
practices and games. Any persistent misconduct will be cause for the parent to leave the practice or
game and if continued, removed for the season.
8. Coaches are volunteers for coaching only, and I agree to ensure my child, if 9 and under, is not left
unattended prior to start and end of scheduled practices and games.
I have read and understand the terms of this registration and participation agreement:
Parent/Guardian:_________________________________________ Date:__________________
PHOTO RELEASE
I hereby grant permission for my child to be photographed or videotaped while involved
in activities connected with the Youth Center Sports Program. No commercial use will
be made of these photographs or videotapes without further consent.
Parent Signature:_________________________________ Date:________________
I authorize emergency treatment for the child named hereon:
Child’s Name_________________________________________________________
Parent Signature:_________________________________ Date:________________
YOUTH AND TEEN CENTER
LIABILITY WAIVER and MEDICAL RELEASE
The undersigned recognizes that injuries sometimes occur in connection with recreation and physical
activities and hereto releases the Youth Programs, United States Air Force, their employees, agents and
volunteers, from any and all liabilities or injuries and damages resulting from and in connection with
such activities.
Parent Signature:_________________________________ Date:________________
NAYS
PARENT CODE OF ETHICS
1. I hereby pledge to provide positive support, care, and encouragement for my child
participating in youth sports by following this Parent’s Code of Ethics Pledge.
2. I will encourage good sportsmanship by demonstrating positive support for all players,
coaches, and officials at every game, practice, or other youth sports event.
3. I will place the emotional and physical well being of my child ahead of a personal desire to
win.
4. I will insist that my child play in a safe and healthy environment.
5. I will support coaches and officials working with my child, in order to encourage a positive
and enjoyable experience for all.
6. I will demand a sports environment for my child that is free of drugs, tobacco, and alcohol,
and will refrain from their use at all youth sports events.
7. I will remember that the game is for youth-not adults.
8. I will do my very best to make youth sports fun for my child.
9. I will ask my child to treat other players, coaches, fans and officials, with respect regardless
of race, sex, creed or ability.
10. I promise to help my child enjoy the youth sports experience by doing whatever I can, such
as being a respectable fan, assisting with coaching or providing transportation.
11. 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.
12. I will read the NYSCA National Standards for Youth Sports and do what I can to help all
youth sports organizations implement and enforce them.
Parent Signature:_______________________________________Date:_________________
Parent Signature:_______________________________________Date:_________________