Kennesaw Girls Softball Association, Inc.

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Fall 2016 Registration Form

PLAYER INFORMATION

* Last Name:

* First Name:

* Street:

* City:

* State:

* Zip Code:

Not a City of Kennesaw Resident

City Resident

* Name of your sanitation provider (i.e. City of Kennesaw, Waste Management Inc, etc...:

* Home Phone:

* Birthdate:

* Email:

* Which program will your daughter participate in:

* Have you ever played with KGSA before?:

If Yes, please list last season played and team name.:

PARENTS/GUARDIANS NAMES

Firstname(s):

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

Preferred Method of Contact:

VOLUNTEER INFORMATION

* Would you be willing to assist your daughters team?:

If so in what way:

By selecting that you would like to assist your daughters team, additional forms will need to be completed. All coaches will need to complete a coach's application in addition to all volunteers will need to complete and pass a background check PRIOR to working with the girls. These forms are available under the "Handouts/Forms" section of our site.

UNIFORM INFORMATION

* Jersey Size:

Requested Jersey number- In the case of duplicates an alternate jersey number may be needed:

* Will you be Participating in the Spring Fundraiser? If no, a $30.00 opt out fee is required. If you choose to opt out be sure to check the box below the fee selection as well.:

WAIVER INFORMATION

Concussion Awareness:

Concussions at all levels of sports have received a great deal of attention and a state law has been passed to address this issue. Adolescent athletes are particularly vulnerable to the effects of concussion. Once considered little more than a minor “ding” to the head, it is now understood that a concussion has the potential to result in death, or changes in brain function (either short-term or long-term). A concussion is a brain injury that results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull as a result of a blow to the head or body. Continued participation in any sport following a concussion can lead to worsening concussion symptoms, as well as increased risk for further injury to the brain, and even death. Player and parental education in this area is crucial – that is the reason for this document. Refer to it
regularly.

I understand the concussion policy and will complete the form as requested *

Refund and Consent Policies

Refund Policy: A partial refund (KGSA, Inc. registration amount only minus the cost of the uniform) will be made only if written notice is given before Opening Day. After Opening Day, no refund will be given. No refund will be given for the park user fee, non resident fee or any clothing purchased through KGSA, Inc.

Consent Policy: I/We the parents of the above named candidate(s) for a position on a Kennesaw Girls Softball Association (KGSA, Inc.) team hereby give my/our consent and approval for her participation in any and all softball activities during the current season. I/We assume all risks and hazards, incidental to such participation including transportation to and from the activities. I/We hereby waive, release, indemnify, and agree to hold blameless KGSA, Inc., the City of Kennesaw, and any organizers, sponsors, supervisors, participants, head coaches, assistant coaches and persons transporting my/our daughter to or from activities, for any claim arising out of any injury to my/our daughter, except to the extent and in the amount covered by accident liability insurance. I/We give our consent to KGSA, Inc. to render first aid to my/our daughter in the event of an injury. I/We further give our consent to KGSA, Inc. to provide additional treatment by qualified emergency medical personnel in the event that I/We are absent from the game/practice in which the injury occurs

Player Insurance/ASA Registration: I agree to allow KGSA to submit my daughters birth certificate as proof of her age for the purpose of obtaining player insurance for the current year and to register her as player withing the ASA organization.

Upon Completion of your registration form please be sure to provide a copy of your child's birth certificate (for insurance reasons) to the KGSA Secretary. Failure to do so may delay the completion of your daughters registration. In addition please go to our Handouts Forms menu and print and sign the Concussion Awareness form. Your daughter will not be able to participate in the program without this form on file.

Thank you

KGSA

I/we agree with the above *

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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Fall 2016 Registration Form