SPARTANS CANADIAN FOOTBALL ASSOC. Box Uptown Center Postal Outlet Victoria, B.C. V8Z 7H5. First Name Last Name Birthdate (DD/MM/YYYY)

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1 SPARTANS CANADIAN FOOTBALL ASSOC. Box Uptown Center Postal Outlet Victoria, B.C. V8Z 7H5 DIVISION Atom Pee Wee Jr. Bantam YEAR BORN PLAYER REGISTRATION First Name Last Name Birthdate (DD/MM/YYYY) Street Address City Postal Code Address (if applicable) Cell Phone (if applicable) PARENT AND/OR GUARDIAN INFORMATION Primary Contact: First Name Last Name Address (if different from above) Preferred Phone # (if different fr above) Mailing Address (if different from above) Secondary Contact: First Name Last Name Address (if different from above) Preferred Phone # (if different fr above) Mailing Address (if different from above)

2 Player Medical History This form is to be kept with the team first-aid kit in case of emergency. ( / / ) First Name Last Name Birthdate (DD/MM/YYYY) - - Care Card Number Family Doctor Doctor s Phone Number Existing Medical Conditions (please circle all that apply) Asthma Diabetes Heart Issues Chronic Chest Pain Blackouts / Concussions Recurring Headaches Seizures Other Medical Conditions not listed (please describe) Previous Injuries/Surgeries Allergies Medications taken regularly Corrective Lenses: YES NO Please list at least 2 Emergency Contacts First and Last Name Relationship to Player Preferred Phone Number Alternate Phone Number First and Last Name Relationship to Player Preferred Phone Number Alternate Phone Number MEDIA RELEASE Please be aware the games will be video recorded for the primary purpose of game review as an additional coaching tool. I grant permission for my child s video footage to be published on Spartans Football social media accounts. I grant permission for my child s name and/or photo to be used in connection with the public promotion of the Victoria Spartans Football Association including but not limited to our website, the local newspaper, or a sports news website. It will be assumed you grant permission for the photo release unless you specify otherwise. Yes or No Yes or No

3 PARENT AND PLAYER CONSENT FORM While the Spartans Canadian Football Association of BC and its directors, coaches and volunteers make every effort to make Canadian style tackle football as safe as possible you must recognize that it is a contact sport and that your child may incur an injury(s). We make every effort to ensure all gear is checked to ensure that players are protected. Injuries may arise from many causes including but not limited to the following: Player to player contact (including blocking and tackling) Contact with the ground Contact with the ball Tripping and falling Slipping and falling Collision with practice equipment such as tackling sleds and dummies Collision with field equipment such as goal posts, down boxes or measurement chain Collision with game officials, coaches, managers or other on field volunteers Accidents while traveling by public or chartered transportation providers Accidents can be the result of nature of the activity and can occur with or without any fault on either the part of the player, the coaches or Spartans Football and its board of directors, or the facility where the activity is taking place. By allowing your son/daughter to participate in this activity, you are accepting the risk of an accident occurring, and agree that this activity, as described above, is suitable for your child. I give (name of player) permission to participate in any event sponsored or approved by the Spartans Football association. I understand that my child may be exposed to certain risks while participating in this activity. Accidents and injuries may occur. Signature of Parent/Guardian Printed name of Parent/Guardian Signature of Player

4 SPARTANS CODE OF CONDUCT Members and participants of Victoria Spartans programs and activities are expected to always conduct themselves in a manner consistent with the values of Spartans Football. This conduct applies to all forms of interaction including but not limited to face-to-face, electronic, or any form of social media. Conduct that violates these values may be subject to sanctions pursuant to the Victoria Spartans Football discipline policy. All participants and members of Victoria Spartans Football Association have the responsibility to: Maintain and enhance the dignity and self-esteem of members and participants by: - Demonstrating respect to individuals regardless of gender, ethnic or racial origin, sexual orientation, age, marital status, religion, political belief, disability or economic status; - Focusing comments or criticism appropriately and avoiding public criticism of athletes, coaches, officials, board members, volunteers, staff and members; - Consistently demonstration the spirit of sportsmanship, sports leadership and ethical conduct and practices; - Ensuring that the rules of the sport and the spirit of such rules are adhered to. Abstain from the use of alcohol and tobacco while participating at Spartans Football athletic events. Abstain from the non-medical use of drugs or the use of performance enhancing drugs or methods. Refrain from any behavior that constitutes harassment, where harassment is defined as comment or conduct, directed towards and individual or group, which is offensive, abusive, racist, sexist, degrading or malicious. Refrain from any behaviour that constitutes sexual harassment, where sexual harassment is defined as unwelcome sexual advances or conduct of a sexual nature when submitting to or rejecting this conduct influences decisions which affect the individual, such conduct has the purpose or effect of diminishing performance, or such conduct creates an intimidating, hostile or offensive environment. Comply at all times with the Constitution, Bylaws, policies, rules and regulations of Spartans Football, as adopted and amended from time to time, including complying with any contracts or agreements executed with Spartans Football. Athletes who have been selected to be a representative of Spartans Football will have an additional responsibility to: Report any medical problems in a timely fashion, where such problems may limit the athlete s ability to train or compete; Participate in all competitions, events or projects to which the athlete has made a commitment; Adhere to Spartans Football requirements regarding clothing and equipment.

5 Social Media Policy Any social media pages or groups bearing the Spartans name or based on Spartan teams must be approved by the Board of Directors and upon request, have a board member with administrative privileges. Conduct of members on these pages must be in accordance with the Spartans Code of Conduct. Violations may lead to sanctions or discipline up to or including expulsion from Spartans Football Association in accordance with the Constitution. By signing below, I am declaring that I will agree to and abide by the Code of Conduct as presented above. Player s Signature As the Parent/Guardian of the player above, I/we will encourage my player to abide by the Code of Conduct as presented above. I/We will also support Spartans Football in the enforcement of the code requirements as written. Parent s/guardian s Signature Policy for the management of concussion and head injury in football Please take a moment as a club official to check if Football Canada concussion information has been provided to all your athletes. Also, please take a moment and check to see if your association s coaches have taken the online education. Football Canada will not defend any association, director or coach who knowingly ignores our concussion policy. All coaches are required to participate in a yearly education program prior to the season and must ensure the following requirements are fulfilled during the season: 1) An informed consent must be signed annually by parents and youth athletes acknowledging the risk of head injury prior to practice or competition; 2) An athlete who is suspected of sustaining a concussion or head injury must be removed from play when in doubt, sit them out ; and 3) An athlete who has been removed from play must receive written clearance from a licensed medical doctor prior to returning to play. Football Canada has developed guidelines, pertinent information and forms to inform and educate coaches, youth athletes, and their parent(s)/guardian(s) of the nature and risk of concussion and head

6 injury including the risks of continuing to play after concussion or head injury. Each member association and club will work in concert with Football Canada to disseminate these materials and ensure all members understand and comply with the new policy. What is needed to comply? All Football Canada Member Associations, Clubs, and Schools: Shall adopt policies for the management of concussion and head injuries in youth football; Shall ensure that all coaches (paid or volunteer) are educated in the nature and risk of concussions or head injuries prior to the first practice/competition (including education in the signs and symptoms of concussions/brain injuries); Shall annually require all players and the parent(s) and/or guardian(s) of those players to sign and return an informed consent form relating to the nature and risk of concussion or head injury (this information sheet shall include the signs and symptoms of concussions/brain injuries); and Shall ensure that any player showing signs or symptoms of a concussion or brain injury is removed from participation/competition immediately and not allowed to return to play until they have written clearance from a licensed medical doctor. COACHES: Shall be educated as to the nature and risk of concussions and head injuries including the risks of continuing to play after concussion or head injury (including education in the signs and symptoms of concussions/brain injuries); Must complete the Making Head Way in Football elearning course available at Please note you will require a CC# to take this course. Upon completion, this course will be permanently noted on your transcript; *NEW FOR 2013* Shall educate their athletes on the signs and symptoms of concussions and encourage athletes to notify a coach or trainer immediately if they or a teammate exhibits those signs or symptoms; Shall immediately remove from participation/competition any athlete who is suspected of sustaining a concussion or head injury; and Shall not allow an athlete who has been removed from play because of a suspected concussion/brain injury to return to play until the athlete has received written clearance from a licensed medical doctor.

7 PARENTS/GUARDIANS: Shall annually review, sign and return to the BC Provincial Football Association via their child s Association, Club, or School an informed consent form on concussions and head injuries prior to the athlete's initiating practice or competition. ATHLETES: Shall annually review, sign and return to the BC Provincial Football Association via their child s Association, Club, or School an informed consent form on concussions and head injuries prior to the athlete's initiating practice or competition; and Shall notify immediately a coach if they or a teammate exhibit signs or symptoms of a concussion/brain injury. Definitions Licensed Medical Doctor is a medical physician with an M.D. or equivalent degree or training that is licensed by the College of Physicians and Surgeons of B.C. For more information, contact (604) or visit Online Resources The following documents can be found at Concussion Information Sheet for Athletes Concussion Information Sheet for Coaches Concussion Information Sheet for Parents Football Canada I have read the rules and guidelines for the concussion protocol. I will notify my Coach and Trainer if I experience a concussion and will follow all the advice as given by a medical doctor. I will NOT engage in further practices or games until such time as I am deemed concussion free by medical standards. Player s Signature Parent s/guardian s Signature

8 PAYMENTS AND FEES The 2017 Registration Fee Schedule is as follows: Standard Registration (March 1 or later) Atom $200 $175 Pee Wee $200 $175 Jr. Bantam $200 $175 *Early Registration (if paid prior to March 1, 2017) **The amounts shown include the player insurance. If you register online, the insurance will show up as a separate line item and the registration amount will reflect the difference. Description Amount on Cheque Cheque # Registration Fee Current d **Volunteer Deposit $100^ Post-d: June 15, 2017 **Gear Deposit $500 Post-d: June 15, 2017 **Girdle Purchase (optional) $40 Current d ** These amounts are NOT covered by financial assistance organizations. Parents/players are responsible. ^ Volunteer Deposit is based on approximately 10 hours of additional support. Please make all cheques payable to: Spartans Football Association. A $35 fee is charged for all NSF cheques. Due to the accounting practices required by the Gaming Commission, please write separate cheques for each fee. DO NOT COMBINE AMOUNTS INTO ONE CHEQUE. Also, make sure to write you player s name in the memo line of your payment. Early Registration: All forms and payments received prior to March 1, 2017 are eligible for a $25 discount IF they are paid in full with payment cashable immediately. Any payment plans will lose the Early Bird discount. Family Discount: Every additional player from the same family is eligible for a $50 discount. FINANCIAL ASSISTANCE If you are applying for financial assistance through an organization such as KidSport, Jumpstart or Athletics for Kids, please include proof of application prior to your player receiving their game jersey. Many of these organizations have a limit to how much you may be entitled to. Please note, you are responsible for the difference between any financial assistance received and the required registration fees.