2015 AZTEC RUGBY SUMMER 7 s REGISTRATION PACKET
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- Cori Copeland
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1 2015 AZTEC RUGBY SUMMER 7 s REGISTRATION PACKET Registration for the Summer 7s rugby season is now open. The season consists of several tournaments starting on June 6 and finishing up with a grand finale SCYR 7s championship tournament on Saturday, July 25th. All players from U10 through U18, boys and girls, are invited to sign up now. Practices will start in mid-late May with more information on practice times and locations for both Dusty Rhodes and Mira Mesa teams available soon. Each tournament team is expected to participate in at least 6 tournaments around Southern California. Please sign up soon as teams fill up fast. If we have enough players sign up, we will open additional teams. If you were registered with an Aztec team for the season (High School or Club) all you need to do is complete the attached, one page Short Form registration packet, attach a check for your registration fees and send them to Pamela Madden at pamelamadden@sbcglobal.net or mail them to Aztec Rugby at 4993 Northaven Ave. San Diego, CA 92110, prior to participating in any club activities. You can also pay registration fees online at If you didn t play for an Aztec team this past season, please complete the attached Long Form registration packet, include all required documents, attach a check for your registration fees and send them to Pamela Madden at pamelamadden@sbcglobal.net or mail them to Aztec Rugby at 4993 Northaven Ave. San Diego, CA prior to participating in any club activities. You can also pay registration fees online at Registration Fees: $50 - Aztec players with valid CIPP number $100 - Non Aztec players with a valid CIPP number $125 - New players not currently registered through Southern California Youth Rugby (SCYR) Registration fees do not include additional tournament fees expected to be $10-$15 per player, per tournament entered. Please make checks made out to San Diego Athletic Club A Not For Profit 501c3 Organization 1
2 2015 AZTEC RUGBY SUMMER 7 s Short Form Registration Packet This form is ONLY for those players who WERE registered with an SDYA Aztec High School or Club team, during the season and have a valid CIPP # Player Name: Date of Birth: Player : Team you played for: Parent Name: Player Phone #: Parent Phone #: Parent Player Signature: Parent Signature: (If under 18) Team Registration and Fees Please select or circle which team you want to join. Age cut off date is September 1, (Ex: Must be under 16 on Sept 1, 2014 in order to play on the U16 team) U10 Co-ed U12 Boys U14 Boys U16 Boys U18 Boys U15 Girls U18Girls Please circle your team location choice, if available: Dusty Rhodes Mira Mesa 2015 Summer 7 s Registration Fee Aztec players - $50 plus tournament fees (TBD) per tournament entered Match jerseys will be provided for tournament play. Your completed short form must be signed and sent in along with you re your full registration fee before you can participate in any on field club activities. You can also pay registration fees online at Packets can be mailed to SDYA Rugby 4993 Northaven Ave, San Diego CA ABSOLUTELY NO REFUNDS There will be no refunds if a player elects to drop for any reason, all fees paid will be considered donations to the San Diego Athletic Club, Youth Rugby Program. FOR OFFICIAL USE ONLY Date: Total Amount Paid $ Check # 2
3 2015 Aztec Rugby Summer 7 s Long Form Registration Packet This form is ONLY for those players who were NOT registered with a SDYA Aztec High School or Club team, during the season but a valid CIPP # Please complete, sign and return all forms along with the following items: Copies of all forms and requested items Full registration fee Provide copies of the following: Legal Birth Certificate School ID (or other form of age grade verification) SCYR required current color photo (head and shoulders only, against a plain background) 2015 Summer 7 s Registration Fees Non Aztec CIPPed Players $100 plus tournament fees (TBD) per tournament entered New (non CIPPed) Players $125 plus tournament fees (TBD) per tournament entered Please make checks payable to San Diego Athletic Club. Match jerseys will be provided for tournament play. Your completed long form must be signed and sent in along with you re your full registration fee before you can participate in any on field club activities. You can also pay registration fees online at Packets can be mailed to SDYA Rugby 4993 Northaven Ave, San Diego CA ABSOLUTELY NO REFUNDS There will be no refunds if a player elects to drop for any reason, all fees paid will be considered donations to the San Diego Athletic Club, Youth Rugby Program. FOR OFFICIAL USE ONLY Date: Total Amount Paid $ Check # 3
4 2015 Aztec Rugby Summer 7 s Long Form Registration Packet Player Name: M / F Date of Birth: / / Team: Grade: Home Mailing Address: CIPP # Home Phone: Cell Phone: Parent/Guardian Player s Emergency Contact Name: Emergency Phone Number: Health Insurance Company: Policy Number: Medical History: Please note any history of medical issues including anything that may limit your ability to participate. ( ) Allergies ( ) Seizures ( ) Diabetes ( ) Other ( ) Medications ( ) Special Needs ( ) Asthma Specific Details: 4
5 2015 Youth Rugby Permission to Participate, Release, Indemnity and Authorization for Medical and Dental Treatment PERMISSION The undersigned (requires parent/guardian signature if under 18) hereby grants permission for him/her to participate in the sport of rugby and related activities with the SDYA Youth Rugby Program. In granting this consent, the undersigned understands and acknowledges the physical nature of the sport of rugby and the risks inherent in such physical activity. The undersigned acknowledges that it has been recommended to him/her that they obtain medical clearance prior to him/her participating in the sport of rugby with the SDYA Youth Rugby program. RELEASE AND INDEMNITY In consideration of the above player being permitted to participate in the activities specified above, the undersigned agrees to not make or join in a claim or civil suit for injury, death or property damage against the SDYA Youth Rugby and the Southern California Rugby Football Union and constituent bodies, the Southern California Referees Society and all affiliated entities, including, without limitation, their respective administrators, staffs, or volunteers including but not limited to all actions, claims and demands the undersigned or the player may hereafter have for injury, death or property damage as consistent with public policy, arising out of participation in the activity specified above. Further, if a claim or civil suit is brought against the SDYA Youth Rugby, SDAC, the Southern California Rugby Football Union and its constituent bodies, the Southern California Rugby Referees Society and all affiliated entities, including without limitation, their respective administrators, staff or volunteers as result of the actions of the above named player for injury, death or property damage, the undersigned agree(s) to indemnify and hold harmless the afore mentioned including, without limitation, their administrators, staff or volunteers from any and all such claims, suits, damages, including judgments and/or settlements, whether such claims arise out of the negligence or intentional misconduct of the above named player, whether such negligence is active or passive and whether individually or in concert with others. AUTHORIZATION The undersigned, as parents or legal guardians of the above named minor player, herby authorize and grant to the supervising or participating adult, permission in the event of illness or injury, while participating in the activity specified above to consent to the following: x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care rendered to the minor under the general or specific supervision and upon the advice of a physician and surgeon licensed under the provisions of the Medical Practice Act or to consent to an x-ray examination, anesthetic, upon the advice of a dentist licensed under the provision of the Dental Practice Act. Said authorization to include the release of any medical or dental records to the attending physician or dentist for review. I also authorize my (or my child s if under 18) photograph to be taken and used for promotional purposes by the SDYA Youth Rugby. Players Name: Date: Signature (Parent signature if under 18): 5
6 2015 Youth Rugby Code of Conduct, Zero Tolerance Policy and Parent Volunteer Form SDYA Youth Rugby Program follows USA Rugby s Code of Ethics. Please read and discuss the following with family members, then sign and return the form with your registration packet. PLAYER CODE OF CONDUCT *Play for enjoyment. *Play hard, but always play fair. Winning isn t everything Honor is! *Play by the laws of the game. *Be committed to your team and attend all matches and practices. *Never argue with the referee s decisions and control your temper. *Work equally hard for yourself and your team. *Be a good sport and applaud all good play whether by your team or opponent. *Remember the goals of the game, have fun, improve your skills, play responsibly. *Be humble in victory and gracious in defeat. PARENT CODE OF CONDUCT *Be positive with all referees and acknowledge their efforts. *Let the coaches run the game. If you see a problem, seek a club official. *Let the players play their game, not the parent s game. *Praise actual efforts not results. *Set a positive example for all players, parents, coaches and visitors. *Do not criticize, belittle or question the ability of any official, coach or player. *Control your emotions at games and events. *Do not yell at, criticize or verbally abuse any player, coach, parent or official. SDYA Youth Rugby reserves the right to ask any player or parent to leave the premises of a game, practice or team event if their behavior is not consistent with the above code of conduct. Our club strictly adheres to its Substance Abuse Policy regarding the possession, use or distribution of alcohol or any illegal drug or controlled substance by any SDYA Youth Rugby player during a SDYA Youth Rugby sponsored event. Any player found to be in violation of this policy would be immediately suspended from participation in all SDYA Youth Rugby activities pending a full review of the circumstances by the Board. The Board s findings may result in continued suspension, expulsion from the club or other disciplinary actions deemed appropriate by the Board. By signing below, you agree to comply with all of the above, as stated. Player Signature: Date: Parent Signature: Date: 2015 Volunteer Form: If you have a special/unique talent that you feel the club would benefit from please let us know. Each team will need a team parent to help coordinate volunteers, and assist the coach. If interested please let your player s coach know and inform any one of the Board members. Throughout the season the club will need help hosting on game days, set-up, serving, and clean-up. Assistance with setting up the fields and take down of the fields will also be necessary. If you are interested in serving on a committee, contact any of the Board members for further assistance. Name: Phone: Area of interest/ special/unique talent: 6
7 MEDICAL INSURANCE AGREEMENT AND USA RUGBY RULES ACKNOWLEDGEMENT 1. I acknowledge that I have a medical insurance policy in my name that has a minimum of $100,000 in medical coverage WITH NO RESTRICTION FOR ACCIDENTS WHILE PARTICIPATING IN SPORTS. I understand such insurance will be my primary source of payment should medical treatment be necessary as a result of my participation in the Activity. 2. I agree to abide by all International Rugby Board, USA Rugby, territorial and local area union rules and regulations, including to be bound by the arbitration procedures therein, that I am aware of and understand, for any dispute regarding my right to participate in the Activity, as set forth in the Bylaws of USA Rugby, as they are amended on a periodic basis, which I understand are available on the USA Rugby web site ( ). 3. I affirm that I am not suspended or banned from play or participation by any club local area union, territorial union, or national union, and I authorize USA Rugby to verify my citizenship status with the appropriate governmental agencies. 4. I am aware that USA Rugby has the right to revoke my CIPP enrollment, and therefore my eligibility to play or coach, in the event of any violation of the above-mentioned statement. WAIVER & RELEASE, ASSUMPTION OF RISK AND PARENTAL INDEMNIFICATION In consideration of me being permitted to participate in any way in USA Rugby, it s member unions, clubs, organizations and individuals sponsored Activities ( Activity ), I agree: 1. I understand the nature/dangers of USA Rugby activities and believe that I am qualified to participate in such Activity. I further acknowledge that I am aware the activity will be conducted in facilities open to the public during the Activity. I further agree/warrant that if at any time I believe conditions to be unsafe, I will immediately cease further participation in the Activity. 2. I FULLY UNDERSTAND that: (a) USA RUGBY Activities involve risks and dangers of SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ( Risks ); (b) these Risks and dangers may be caused by my own actions, or inaction s, the actions or inaction s of others participating in the Activity, the condition in which the Activity takes place. Or THE NEGLIGENCE OF THE RELEASEES NAMED BELOW; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of my Participation in the Activity. 3. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS USA RUGBY, their member unions, territorial unions, clubs, respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place (each considered one of the Releasees herein) from all liability, claims demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations and further agree that if, despite this release, I or anyone on my behalf makes a claim against any of the Releasees named above, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE OR COSTS ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDIN G, SHALL CONTINUE IN FULL FORCE AND EFFECT. Printed Name: Signature: (Parent, if under 18): Date: 7
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