Bay St. Louis Dixie Girls Softball

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Coach Registration Form

COACH INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Cell Phone:

* Work Phone:

* Birthdate:

* Email:

* Gender:

* Occupation:

* Have you coached in BSL Dixie Softball Since 2013?:

Coaches from the previous year will be given first option to coach if there are more volunteers than positions.

* I want to be:

* I want to coach:

I am requesting to coach with:

* Uniform T-Shirt Size (No Re-orders):

* Do you have a child playing in the league?:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Coach:

* Insurance Carrier:

Policy #:

ADULT WAIVER/RELEASE INFORMATION

In consideration of being allowed to participate in any way in the Bay St. Louis Dixie Girls Softball athletic sports program, related events and activities, the undersigned acknowledges, appreciates and agrees that:

1) the risk injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2) I KNOWLINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES others, and assume full responsibility for my participation; and,

3) I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Bay St. Louis Dixie Girls Softball, their officers, board members, officials, agents, volunteers and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I have read this Release of Liability and Assumption of Risk Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. *

* Date:

CONSENT/RELEASE:

I authorize and give consent for BSL Dixie Girls Softball to obtain my personal information.

This includes, but is not limited to employment records/employer's references; criminal background records/information; criminal background checks/fingerprints; driving record check, financial bankruptcy information, coaching experience, personal references, and addresses.

I authorize this information to be obtained either in writing, via nternet, or via telephone in connection with my volunteer application.

I understand that my position is contigent upon adverse information about my background or character not being uncovered upon the performance of the above referenced checks. I also understand that regardless of my prior volunteer activities on behalf of BSL Dixie Girls Softball, that BSL Dixie Girls Softball is not required to all my continued participation.

I agree to hold harmless and indemnify from liability BSL Dixie Softball and its Officers, Board Members, Volunteers, Employees and Officials from all liability arising out of the use of the information that is uncovered in the above referenced checks.

I agree to the above consent/release *

* Date:

PUBLIC RELATIONS & IMAGE RELEASE

The undersigned agrees that their likeness, or the likeness of themselves in consideration of participation in Bay St. Louis Dixie Girls Softball does hereby authorize consent and grant full permission to Bay St. Louis Dixie Girls Softball, its Officers, Board Members, Volunteers, Employees and Officials, to use any photographs, videotapes, video images, motion pictures, website images, recordings or any other recordings arising from my participation in the Bay St. Louis Dixie Girls Softball league and its events and that such image may be published in an outlet used to promote or publicize the Bay St. Louis Dixie Girls Softball program.

I agree to the Public Relations & Image Release *

* Date:

Note:There will be a minimal fee associated with your 3rd party background check.

Thank you for volunteering to continue to make this league a success. We look forward to a great season!

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Coach Registration Form