Kitsap Peninsula Adult Pee Wee Association
Coaches Pledge
Name of Club
Team (include level/color)
Club President
Name
Certification
Phone Number
Date
Renewal Date
In accordance with the KPAPWA General Rules all coaches must read, sign and have on file with the 2nd VicePresident, the following Coaches Pledge that is intended to bind the coaches to the purpose and policies of this
association. Coaches are encouraged to become certified in the sport to which they are volunteering KPAPWA
is authorized to require that you complete a Volunteer Application/Disclosure Statement and a Washington
State Patrol Request for Criminal History in accordance with the Child/Adult Abuse Information Act each
sports season.
By my Signature below, I pledge to:
1. Abide by the by-laws, general rules, and playing rules of this association.
2. Actively promote the objectives of the organization i.e.: To implant firmly in the youth under my charge
the ideals of good sportsmanship, honesty, loyalty, courage and reverence.
3. Conduct myself in a mature and sportsman-like manner.
4. Refrain from smoking, use of profanity or other acts which if repeated by the youths would be at
variance with the objectives of the organization while on the field or bench area with the youth.
Moreover, holding the safety and well-being of the youth to be of paramount importance, I pledge to:
5. Make every effort to learn and implement a program of training which will minimize the chance of
injury through lack of conditioning.
6. Play only those players who are physically fit to the best of my ability.
I understand that if charged with violation of this pledge, I may be required to appear before the Executive
Board to answer the charge. For flagrant or repeated violation, which is substantiated at a hearing by Executive
Board, I acknowledge that KPAPWA has the power to restrict or remove me as a Pee Wee coach.
Signature
Date
Attachment 1.A
Kitsap Peninsula Adult Pee Wee Association
Coaches Pledge
In accordance with the KPAPWA General Rules all coaches must read, sign and have on file with the 2nd VicePresident, the following Coaches Pledge that is intended to bind the coaches to the purpose and policies of this
association. Coaches are encouraged to become certified in the sport to which they are volunteering KPAPWA
is authorized to require that you complete a Volunteer Application/Disclosure Statement and a Washington
State Patrol Request for Criminal History in accordance with the Child/Adult Abuse Information Act each
sports season.
By my Signature below, I pledge to:
1. Abide by the by-laws, general rules, and playing rules of this association.
2. Actively promote the objectives of the organization i.e.: To implant firmly in the youth under my charge
the ideals of good sportsmanship, honesty, loyalty, courage and reverence.
3. Conduct myself in a mature and sportsman-like manner.
4. Refrain from smoking, use of profanity or other acts which if repeated by the youths would be at
variance with the objectives of the organization while on the field or bench area with the youth.
Moreover, holding the safety and well-being of the youth to be of paramount importance, I pledge to:
5. Make every effort to learn and implement a program of training which will minimize the chance of
injury through lack of conditioning.
6. Play only those players who are physically fit to the best of my ability.
I understand that if charged with violation of this pledge, I may be required to appear before the Executive
Board to answer the charge. For flagrant or repeated violation, which is substantiated at a hearing by Executive
Board, I acknowledge that KPAPWA has the power to restrict or remove me as a Pee Wee coach.
Name of Club
Coaches Name
Team (include level/color)
Signature
Attachment 1.B
Club President
Date
Kitsap Peninsula Adult Pee Wee Association
Club Waiver Form
Sport: ________________________________
Year:________________________
Home Club Requesting Waiver: ___________________________________________________________
“New” Club to which player(s) will waive: __________________________________________________
___________________________________________________
Player Name(s):
________________________________________
Level:
____________________________
________________________________________
____________________________
________________________________________
____________________________
___________________________________________________
Reason for Waiver:
If Full Team then:
FULL TEAM____________
NO TEAM_______________
Effective Date in which team was full:_______________________
Number of Players currently on team: _______________________
I acknowledge that this is a ONE TIME waiver and that said player(s) must register and play for their
home club hereafter. NO EXCEPTIONS WILL BE ALLOWED.
Parent/Guardian Signature: __________________________________________ Date: _______________
Printed Name of Parent/Guardian: ________________________________________
___________________________________________________
The above named player(s) has registered with their home district. I certify that the above waiver request
information is accurate. I acknowledge that if this is due to a full team that no more players may be added
at this level. (This form will be faxed within 48 hours of signature to County Eligibility chairperson)
Home Club Eligibility Signature: ______________________________________Date: _______________
Printed Name of Approver and Position Held: ________________________________________________
___________________________________________________
I acknowledge that the above waiver request will put this player into my district and that our club can place
this player on a team for THIS SPORT. (This form will be faxed within 48 hours of signature to County Eligibility
chairperson)
Transfer Club Eligibility Signature: ____________________________________Date: ________________
Printed Name of Transfer Club and Position Held: _____________________________________________
___________________________________________________
A copy of this waiver must be filed with the “home” and “transfer” club registrars. The original copy goes
to Central Council Registrar for action. THIS REQUEST IS FOR THE SAID SPORT ONLY!
Central Council Eligibility: ___________________________________________Date: _______________
Attachment)2)
Kitsap Peninsula Adult Pee Wee Association
Move Release Form
Player Name: _________________________________
Level: _____________________
Previous Address: _______________________________________
_______________________________________
_______________________________________
Length of time at Old Residence: ______________
Pee Wee Club: ______________
Present Address: _______________________________________
_______________________________________
_______________________________________
Date moved to New Residence: ______________
Pee Wee Club: ______________
______________________________________________
We are requesting that ____________________________ be allowed to continue to play for _______________
Pee Wee Association for the rest of his/her sports career. We understand that under no circumstances will we be
allowed to reconsider and play for another Pee Wee Association.
Player: ______________________________________________________ Date: _______________________
Parent/Guardian: ______________________________________________ Date: _______________________
______________________________________________
The above player has been a registered player in our district. I certify that it has been explained to the player and
parent/guardian that this is for the duration of the players Pee Wee career and cannot be changed.
Club Eligibility: _______________________________________________ Date: _______________________
______________________________________________
A Copy of this release must be filed with the Central Council Eligibility Chairperson. Copies will go to both
clubs for their records.
Central Council Eligibility: ______________________________________ Date: _______________________
Attachment 3
Kitsap Peninsula Adult Pee Wee Association
Coach-Parent Conduct Conference
!
1. Disrespectfully addressing officials and showing resentment toward decisions and violations of the rules
should not occur even though an official may make an error. Coaches, participants and spectators must
realize there is no game in which coaches and players do not also make errors.
2. No one would tolerate poor sportsmanship toward the coach or players because of this. In the same
regard, everyone must show respect toward game officials.
3. Coaches, players, parents and fans that show disrespect to opposing players and officials are a liability
rather than an asset to the Pee Wee program.
4. The following are important items for good sportsmanship:
a. Courteous treatment of all officials, opposing players and fans.
b. Refraining from derogatory remarks addressed toward officials and players, taunting actions and
cheering decisions made by officials against opposing teams.
c. Graciously accepting the decisions of the officials against a team by refraining from making
unsportsmanlike comments, booing and jeering.
d. Be humble in victory and gracious in accepting defeat.
5. The action of a few individuals ruins the enjoyment for the majority of parents or fans that demonstrate
their approval and support when their team does something right, who suffer in silence when things go
wrong and who do not blame the officials for each loss.
Signature of Parents:
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
Attachment 4
Kitsap Peninsula Adult Pee Wee Association
Code of Conduct
!
1. Coaches, parents and fans are an essential part of the young athletes participation in Pee Wee sports.
Parents and fans should cheer for their team and the players on that team.
2. Coaches, players, parents and fans shall not act in an unsportsmanlike manner, make uncomplimentary
remarks toward game officials at any time and in any way set a poor example for their child or any of
his/her teammates.
3. Coaches, players, parents and fans shall not confront or accost a game official at any time.
4. Coaches, players, parents and fans shall not act in a demonstrative manner that might incite anyone
against game officials.
5. Coaches, players, parents and fans shall conduct themselves in a manner that upholds the values of
sportsmanship.
6. The head coach is responsible for all conduct on their sideline. This includes assistant coaches, players,
parents and fans.
UNSPORTSMANLIKE CONDUCT
Examples are but not limited to:
a. Using profanity, insulting or vulgar language, and demonstrative gestures.
b. Attempting to influence a decision by an official.
c. Disrespectfully addressing an official.
d. Indicating objections to an official’s decision.
I agree to abide by the above code of conduct. Failure to comply with the above code of conduct will result in
suspension from Pee Wee activities.
Players Name: ________________________________________________________________
Parent/Guardian Signature: ______________________________________________________
Parent/Guardian Signature: ______________________________________________________
Date: ______________________________________
Attachment 5
Kitsap Peninsula Adult Pee Wee Association
GAME DAY GUIDELINES
1. Parking spots will be reserved for all officials. If 2 or 3 games at a site, 3 spots (1
crew). If more than 3 games, 6 parking spots (2 crews) are required. This will
eliminate the 2nd crew of officials having to park a distance from the field.
2. It is RECOMMENDED the HOME team game manager meet the officials at their
parking spots and required to keep parking available for the 2nd crew (if applicable).
3. The VISITING game manager will introduce themselves to the home team game
manager, and to the officials. IT is recommended that this be done before officials
meet with the head coaches. If it is not done before the meeting with the coach, the
officials will ask head coach for their game manager and the game will not start until
introduction of game manager and the Referee knows the game manager is aware of
their responsibility.
4. IT is recommended (or if requested by the Referee) that the game managers (HOME
and VISITOR) will check with the officials at halftime for any possible problems.
5. After the game, if requested by the officials, the game manager will walk with the
officials to their cars and stay with them until the officials have driven away.
GAME MANAGER DUTIES
1. Assist the head coach in keeping sideline control in conformance with the Pee Wee code
of Conduct. Request, coaches, parents and fans not conforming to the Pee Wee Code of
Conduct, to leave the game site. Ensure that any Coach, parent, or fan that is ejected
leaves the field. Call 911 as required to remove any coach, parent or fan from the field.
Note the name(s) of the coach, parent or fan, and forward to Central Council and the
Peninsula Football Officials Association (PFOA)
2. Assist the game referee as requested, either directly or via the head coach. Ensure no
coach accosts any official before, during or after any game. Note the name(s) of any
person attempting to do so and forward to Central Council and PFOA
3. Game managers shall not engage in any conduct that violates the spirit, intent or the
written word of the Pew Wee code of Conduct. Game managers walk the sideline and set
a good example for all parents and fans
Attachment 6
Kitsap Peninsula Adult Pee Wee Association
Concussion Management Pamphlet
Concussion Information Sheet
A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the
head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild
to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all
concussions are potentially serious and may result in complications including prolonged brain damage
and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can
be serious. You can’t see a concussion and most sports concussions occur without loss of consciousness. Signs
and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If
your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself,
seek medical attention right away.
Symptoms-may-include-one-or-more-of-the-following:--
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Headaches
“Pressure in head”
Nausea or vomiting
Neck pain
Balance problems or dizziness
Blurred, double, or fuzzy vision
Sensitivity to light or noise
Feeling sluggish or slowed down
Feeling foggy or groggy
Drowsiness
Change in sleep patterns
Amnesia
“Don’t feel right”
Fatigue or low energy
Sadness
Nervousness or anxiety
Irritability
More emotional
Confusion
Concentration or memory problems
(forgetting game plays)
! Repeating the same question/comment
)
Signs observed by teammates, parents and coaches include:
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Appears dazed
Vacant facial expression
Confused about assignment
Forgets plays
Is unsure of game, score, or opponent
Moves clumsily or displays incoordination
Answers questions slowly
Slurred speech
Shows behavior or personality changes
Can’t recall events prior to hit
Can’t recall events after hit
Seizures or convulsions
Any change in typical behavior or personality
! Loses consciousness
)
Attachment)7)
Kitsap Peninsula Adult Pee Wee Association
Concussion Management Pamphlet
What can happen if my child keeps on playing with a concussion or returns too soon?
Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to
play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater
injury. There is an increased risk of significant damage from a concussion for a period of time after that
concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the
first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with
devastating and even fatal consequences. It is well known that adolescent or teenage athletes will often fail to
report symptoms of injuries. Concussions are no different. As a result, education of administrators, coaches,
parents and students is the key to student-athlete’s safety.
If you think your child has suffered a concussion
Any athlete even suspected of suffering a concussion should be removed from the game or practice
immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how
mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete
should continue for several hours. The new “Zackery Lystedt Law” in Washington now requires the consistent
and uniform implementation of long and well-established return-to-play concussion guidelines that have been
recommended for several years:
“a youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be
removed from competition at that time”
and
“...may not return to play until the athlete is evaluated by a licensed heath care provider trained in the
evaluation and management of concussion and received written clearance to return to play from that
health care provider”.
You should also inform your child’s coach if you think that your child may have a concussion. Remember it’s
better to miss one game than miss the whole season. And when in doubt, the athlete sits out.
RETURN TO PARTICIPATION PROTOCOL
If you child has been diagnosed with a concussion they MUST follow a progressive return to participation protocol
(under the supervision of an approved health care provider) before full participation is authorized.
The return to play protocol may not begin until the participant is no longer showing signs or symptoms of
concussion. Once symptom free, the athlete may begin a progressive return to play. This progression begins with
light aerobic exercise only to increase the heart rate (5-10 minutes of light jog or exercise bike) and progresses each
day as long as the child remains symptom free. If at any time symptoms return, the athlete is removed from
participation.
For current and up-to-date information on concussions you can go to http://www.cdc.gov/ConcussionInYouthSports/
Adapted from the CDC and the 3rd International Conference on Concussion in Sports
Document created 6/15/2009
Attachment)7)
Kitsap Peninsula Adult Pee Wee Association
Concussion Management and Sudden Cardiac Arrest Awareness Acknowledgement Form
!
Kitsap Peninsula Adult Pee Wee Association believes participation in athletics improves
physical fitness, coordination, self-discipline, and gives children valuable opportunities to learn
important social and life skills.
With this in mind it is important that we do as much as possible to create and maintain an
enjoyable and safe environment. As a parent/guardian or athlete you play a vital role in
protecting participants and helping them get the best from sports.
Player and parental education in this area is crucial which is the reason for the Concussion
Management and Sudden Cardiac Arrest Awareness Pamphlets you received. Refer to it
regularly.
This form must be signed each season by the parent/guardian and athlete prior to participation
in Kitsap Peninsula Adult Pee Wee Association athletics. If you have questions regarding any
of the information provided, please contact the athletic director at your club.
I HAVE RECEIVED, READ AND UNDERSTAND THE INFORMATION PRESENTED
IN THE CONCUSSION MANAGEMENT AND SUDDEN CARDIAC ARREST
AWARENESS PAMPHLETS.
!
_________________________________
Athlete&Name&(Printed)&&
_________________________!_______!
Athlete&Name&(Signed)&Date&&
_________________________________!
Parent/Guardian&Name&(Printed)&&
_________________________!________!
Parent/Guardian&Name&(Signed)&Date&!
)
Attachment)7)
Kitsap Peninsula Adult Pee Wee Association
Member Association Team Colors
Association Name
Basketball
Baseball
N/A
N/A
Red/White/Gray/Black
Red/White
Red/White
North Kitsap
Black/White
Black/White
Black/Purple/White
North Mason
Black/White/Gray
Black/White/Gray
Black/White/Gray
North Perry
Green/Black/White/Gray
Green/Black/White/Gray
Green/Black/White
Silverdale
Orange/White
N/A
Orange/White
South Kitsap
Maroon/Silver
N/A
Maroon/Gray/White
Purple/Gold/White/Black
Purple/Gold/White
Purple/Gold/White
Blue/Gold
Blue/Gold/White
Blue/Gold/White
Bainbridge Island
Chico
Football
Kingston
Port Townsend
Tracyton
Warren Avenue
Attachment 8
January
ScheduleBaseballrulesmeeting
DeterminePlayoffandchampionshiplocations
February
NotifyMasterrosterduedateforBaseball
NotifyGameRosterMasterduedatefor
Baseball
NotifyBaseballTeams/Fieldavailability/
Coachesinformationdueto2ndVP
Notifyclubsofpre-assessmentcosts
NotifyclubsofWSPandCoachPledgesduedate
FinalizeChampionshiplocations
HoldBaseballrulesmeeting
March
ApproveChangestoBaseballRules
NotifyclubsofboardmembervotinginApril
April
Voteonboardmembers
ScheduleGeneralrulesmeeting
ScheduleavailableforBaseball
DeterminePlayoffandchampionshiplocations
Basketballseasonreview/suggestions
May
ScheduleFootballrulesmeeting
NotifyClubstosubmitBy-Lawstoboard
FinalizeChampionshiplocations
June
HoldGeneralRulesmeeting
HoldFootballrulesmeeting
ReceiveupdatedcopyofallclubsBy-Laws
Agenda
ActionItems
HoldGeneralRulesmeeting
ScheduleavailableforBasketball
ActionItems
Agenda
MasterRostersBaseballdue
GameRosterMastersdue
BaseballTeams/Fieldavailability/Coaches
informationdueto2ndVP
Pre-assessmentsdue
WSPandCoachPledgesdue
July
ApproveChangestoFootballRules
NotifyFootballTeams/Fieldavailability/
Coachesinformationdueto2ndVP
Notifyclubsofpre-assessmentcosts
NotifyclubsofWSPandCoachPledgesdue
date
Baseballseasonreview/suggestions
August
ScheduleGeneralrulesmeeting
September
Schedulebasketballrulesmeeting
DeterminePlayoffandchampionshiplocations
FootballTeams/Fieldavailability/Coaches
informationdueto2ndVP
Pre-assessmentsdue
WSPandCoachPledgesdue
HoldGeneralRulesmeeting
Scheduleavailableforfootball
October
FinalizeChampionshiplocations
November
ApproveChangestoBasketballRules
NotifyBasketballTeams/Fieldavailability/
Coachesinformationdueto2ndVP
Notifyclubsofpre-assessmentcosts
NotifyclubsofWSPandCoachPledgesduedate
December
ScheduleGeneralrulesmeeting
Footballseasonreview/suggestions
HoldBasketballrulesmeeting
BasketballTeams/Fieldavailability/Coaches
informationdueto2ndVP
Pre-assessmentsdue
WSPandCoachPledgesdue
ActionItems
Agenda
ActionItems
Agenda