CHESTERFIELD CHARGERS OFFICIAL REGISTRATION FORM

CHESTERFIELD CHARGERS OFFICIAL REGISTRATION FORM Participant Information: Name: Address: Zip Code: Date of Birth: City: Current Weight: Mother s Cell Number: Parent s Consent Father s Cell Number: I, the parent of a candidate for a position on a team of Chesterfield Youth Football & Cheer (CYFC), hereby give my consent for his/her participation in any and all of the Oakland Macomb Youth Football Association (OMYFA) and CYFC activities during the current season. I assume all risks and hazards incidental to such participation, including transportation to and from the activities; and I do hereby waive, release, indemnify, and agree to hold harmless CYFC, the OMYFA, and all Franchises of the OMYFA, organizers, sponsors, coaches, supervisors, officers, directors, administrators, volunteers, medical professionals, participants, and persons transporting my child to or from the activities from any and all claims, liabilities, and causes of action related to or arising out of my child s participation. I also grant consent for medical care deemed necessary in the event of any injury to my child, and permission for the Franchise to take photographs of my child to satisfy League registration rules. I hereby certify that the birth certificate or other proof of age used in the registration of my child is true and correct. I fully understand that should otherwise be proved true, league sanctions may be enforced against the franchise my child participates and or my child. I certify that a physician who has found him/her fit for participation in the sport of football/cheerleading has examined my child. I agree to furnish my child with the prescribed shoes and such other personal equipment as is necessary for his/her health and safety. I will adhere to the CYFC Parent / Guardian Agreement, CYFC Participant Code of Conduct, CYFC By-Laws, CYFC Official Rules, OMYFA By-Laws, and OMYFA Rules. If any such rule or requirement is violated, I understand that the OMYFA and/or CYFC may suspend or terminate participation in League or Franchise activities for me and/or my child. Mother s Name: Father s Name: Parent/Guardian s Signature: Date: E-Mail Address: @ FOR INTERNAL USE ONLY League Age: Weight: Team Assignment: Cheer Football Level: Flag Freshman JV Varsity CYFC Required Documents: Volunteer/Fundraiser Equipment/Refund Birth Certificate Physical/Exam Participant C.O.C. Parental C.O.C Media Release Form Concussion Form

Chesterfield Chargers Youth Football and Cheer Code of Conduct In promoting the ethics, safety, and spirit of youth football, Chesterfield Chargers Youth Football and Cheer (CCYFC) has adopted this Code of Conduct in addition to the Oakland Macomb Youth Football Association (OMYFA) Code of Conduct. This Code of Conduct is binding upon all its participants: Board Members, Coaches, Players, Cheerleaders, Parents, Volunteers and Spectators. Violations of this Code of Conduct will result in disciplinary action against any offender. Unsportsmanlike Conduct Unsportsmanlike conduct shall include the following: fighting, verbal abuse, bullying of a team member or dissent toward an official or opponent, racial or ethnic slurs, inappropriate comments or actions that may be construed as sexual harassment, profanity, obscene gestures, flagrant and violent fouls, taunting, trash talk, baiting, cheating, throwing or abusing equipment, physical intimidation or abuse of an official or opponent, and unauthorized leaving of a team bench area. Board Members & Coaches a) Will show the proper respect to all and be held to the highest standards of moral conduct and character both on and off the field. b) Will not at any time push, shove, punch, kick, fight or be guilty of physical contact as an Aggressor upon any official, player, cheerleader, coach or spectator. c) Will not verbally abuse, sexually harass or threaten any official, coach, player or others. d) Will not harass or bait any official, player, coach, cheerleader, spectator or other(s). e) Will not use tobacco, alcohol or illegal narcotics in front of players/cheerleaders during practices, games, or be present during practices, games, under the influence of alcohol or illegal narcotics. This rule applies anytime a coach or board member is representing the Chesterfield Chargers. f) Will show the same respect that is due to all participants, including: other coaches, players, cheerleaders, spectators and league officials. g) Will not act in any way that is detrimental to themselves, their team, the CCYFC, or the OMYFA. h) Will inform the Board of Directors of any rule violation by other Board Members, coaches, players, cheerleaders, managers, spectators or other(s). Board Member(s) will document any observed violation along with date and time of the incident. i) In all dealings with team personnel including coaches, other coaches, players, cheerleaders, spectators Board Members and Coaches will show the same respect and fairness that is due all participants of this organization.

Football Players and Cheerleaders a) Will show the proper respect to all and be held to the highest standards of moral conduct and character both on and off the field. b) Will stay in the team-designated area(s), unless excused to leave by a coach, parent or guardian. c) Will not at any time push, shove, punch, kick, fight, bully or be guilty of physical contact as an aggressor upon any official, board member, coach, player, cheerleader, spectator, or other(s). d) Will not verbally abuse, sexually harass or threaten any official, board member, coach, player, cheerleader, spectator, or other(s). e) Will not harass, bait or be guilty of objectionable demonstration or dissent at any Official s or coach s decision. f) Will not refuse to abide by an official s or coach s decision. g) Will not disobey or attempt to circumvent rules and regulations or the intent thereof. h) Will not use tobacco, alcohol or illegal narcotics or act in any way that is detrimental to themselves, their team, Chesterfield Chargers or OMYFA. i) Will not post threatening or negative comments through the use of social media such as Facebook, twitter or any such venues including Hudl and/or other applications the CCYFC chooses to use for parent, coach and player interactions. Parents, Spectators, Volunteers and Others a) Will show proper respect to all. b) Will not at any time push, shove, punch, kick, fight or be guilty of physical contact as an Aggressor upon any official, board member, coach, player, cheerleader, or spectator. c) Will not verbally abuse, sexually harass or threaten any official, board member, coach, player, cheerleader, spectator or other(s). d) Will not harass or bait any official, board member, coach, player, cheerleader, spectator or other(s). e) Will not directly contact or interfere with coaches or players during a game or practice. f) Will not be in the coaching box, player s area, or on the game field/area prior to, during, or at the conclusion of a game, unless the President, GM or Head Coach has given permission to do so. g) Will not use tobacco, alcohol or illegal narcotics in front of players/cheerleaders during practices, games or be present during practices, games, under the influence of alcohol or illegal narcotics. h) Will not act in any way that is detrimental to themselves, their team, their community, the Chesterfield Chargers or OMYFA. i) Will not post threatening or negative comments through the use of social media such as Facebook, twitter or any such venues including Hudl and/or other applications the CCYFC chooses to use for parent, coach and player interactions

Disciplinary Action The Board of Directors of CCYFC shall have the power to impose any disciplinary action(s) it deems necessary and appropriate for those who fail to abide by the CCYFC By-laws and Code of Conduct. Disciplinary action can range from a written reprimand to being barred from participation or association with CCYFC and the OMYFA and its members. The following and any other acts so deemed by the Board of Directors will constitute grounds for disciplinary action: 1) Striking or abusing physically and/or verbally any official, coach, player, cheerleader, spectator, or other(s). 2) Acting in an unsportsmanlike manner. 3) Violating the CCYFC By-laws and the OMYFA By-laws. Violating the CCYFC Code of Conduct. 4) Ejection (removal) from a game. 5) Using tobacco, alcohol or illegal narcotics at a league game, practice or event. 6) Acting in a way that is detrimental to themselves, their team, and/or The Chesterfield Chargers Youth Football and Cheer Club. 7) The use of Social Media in a threatening or negative way will not be permitted or tolerated this includes Facebook, twitter, or any other such venues including Hudl and/or other application the CCYFC chooses to use for parent, coach and player interactions. 8) Any actions on or off the field that result in a legal conviction of a criminal act as determined by a court of law or other actions that are judged by the Board of Directors to be of such a serious nature that they seriously and negatively impact the CCYFC s or the OMYFA, the image in the community and present the potential for liability to the Board Members and/or the CCYFC or the OMYFA. Anyone who does not abide by the above CCYFC Code of Conduct and By-laws or the OMYFA By-laws governing football can and will be asked to leave the game or event, and may be barred from attending any other CCYFC or OMYFA sponsored game or event. The President of the Chesterfield Chargers, General Manager or Head Football Coach of a Chesterfield Chargers team has the power to ask and if necessary, remove anyone whom they deem to be in violation of the CCYFC s By-laws or Code of Conduct. Upon taking such action, said person must notify the President of the CCYFC.

Ejection and Suspension a) Any coach, player, cheerleader, parent, spectator, or anyone else whether associated or not associated with the CCYFC who is ejected (removed) from a game or practice is automatically suspended from attending and/or participating in the next scheduled game or practices for a week. This rule is NOT subject to protest or review. (Removal from a game or practice shall be interpreted to include the playing/practice field and the spectator area.) b) A second offense by the same person during the same season and/or during the following season will result in immediate suspension for the remainder of the then current year. c) A third offense by the same person will result in immediate lifetime suspension from participating or attending any Chesterfield Charger or OMYFA games and/or any activity sponsored by the Chesterfield Chargers or OMYFA. PLEASE NOTE: 1) While on suspension, the coach, player, cheerleader, parent or other(s) may not attend any practices or games in which any Chesterfield Charger s football team participates. 2) Those who receive suspensions must take the initiative to contact the Board to apply for reinstatement. 3) The Board of Directors shall reserve the right to impose any penalties or disciplinary actions it deems necessary and appropriate for violations of the Chesterfield Chargers or OMYFA Bylaws and/or Code of Conduct.

Fact Finding Hearing Prior to any decision by the Board of Directors for disciplinary action for board members, coaches, players, parents or spectators or other(s), a Fact Finding Hearing before a minimum of two thirds of the Board will be held behind closed doors by the Board of Directors, with notice given to all involved, via 1) Telephone 2) email, and/or U.S. Mail. Said hearing should take place within a reasonable amount of time of the alleged incident unless two thirds of the Board of Directors cannot be present. The board must then schedule the next available date (best efforts) that two thirds of the board will be present. Hearing Process 1) The President (or Vice President if President is not available) shall run the hearing. 2) The President (or Vice President if President is not present) shall read the charges brought against the accused. 3) The Board of Directors MAY then hears from both sides and/or witnesses in an orderly manner. 4) The Board of Directors shall then determine whether sufficient facts and/or evidence have been presented to warrant the holding of the hearing on some or all of such charges with the person(s) violating the Code of Conduct. 5) The Board of Directors shall then judge whether or not the preponderance of the evidence presented in a hearing shows the accused to have committed the acts alleged. 6) The Board of Directors (by majority vote) shall then impose any disciplinary action(s) it deems necessary and appropriate, and/or as specified in the By-laws and Code of Conduct, if the accused is judged to have committed such act or acts as brought before the board. 7) If the accused does not appear at the hearing, the Chesterfield Chargers Board of Directors will render their decision and the accused person(s) will be notified of the disciplinary action to be taken via telephone with a follow-up written notice via email or certified U.S. Mail. Complaints, Allegations, Grievances Improper conduct should be reported to the Football General Manager, President, Vice President, Head Football Coach, or Cheerleading Director of the Chesterfield Chargers within 24 hours of incident. Those who are found guilty of improper conduct will be subject to disciplinary action by the CCYFC Board of Directors (see above). Complaints, allegations, or grievances should be brought to the immediate attention of the President, and/or a sitting Board Member of the CCYFC who shall then do the following: a) Make note of complaint, allegation or grievance and date and time of incident and date and time of complaint, allegation or grievance. b) Notify, within 24 hours of date/time of complaint, allegation or grievance, the President (if not available, then the Vice President) of the Chesterfield Chargers that a complaint, allegation or grievance has been made.

Code of Conduct This is to certify that we the undersigned, have read, understand, and promise to agree by the Code of Conduct set forth by the Chesterfield Chargers Youth Football and Cheer Club. Parent or Guardian Signature Date (Please Print Name) Athlete 1 Signature Athlete 2 Signature Athlete 3 Signature Athlete 4 Signature

CHESTERFIELD CHARGERS VOLUNTEERING ACKNOWLEDGMENT VOLUNTEERING As a parent/guardian of a registered player/cheerleader with the Chesterfield Youth Football & Cheer organization, I hereby understand and agree that all member families are required to volunteer for various posts/duties throughout the organization and football/cheer season. Failure to fulfill volunteer commitment requirements will result in the loss of Returning Player rights the following season and could lead to expulsion from CYFC. 1. Game Commitments Every family in the Chargers organization is required to sign up for 3 Game Commitments per child (no more than 6 per family). These consist of; working concessions, game taping, spirit wear sales, 50-50 raffles, chain gang, pink game, and score keeper, or by joining the Banquet Committee, Pink Game Committee, or Homecoming Committee. Being a member of a Committee satisfies all Game Commitments for the season. Failure to honor the Game Commitments will result in forfeiture of Returning Player/Cheerleader status for the following season. Sign-ups for Game Commitments take place at the Parents Meeting in July, equipment handouts in July/Aug and online. 2. No Show/Missed Commitment Penalty - No commitment changes/cancellations will be accepted less than a week (seven days) before a home game. A volunteer must find a replacement or be subject to the no show/missed commitment penalty. 3. If you do not show for a commitment, the CYFC will charge you $150. You can earn your money back when you complete your volunteer commitments in full for the season. Your athlete will NOT be able to participate in practice or play in games until the $150 is paid. No exceptions. This rule will be strictly enforced. (Cash or check will be held and returned once commitments are fulfilled. If commitments are not fulfilled, the $150 will be forfeited and considered a donation). Signature: Date:

CHESTERFIELD CHARGERS MEDIA RELEASE FORM (OPTIONAL) During the course of a season many of our football players and cheerleaders will be photographed during games and/or practices by their parents or by the Photography Company we employ during the season. We may on occasion ask for some of these images to help us promote the Chesterfield Chargers on our website (www.ctchargers.net), Facebook page, official documents, or our end-of-season yearbook. By signing below you are giving Chesterfield Youth Football & Cheer permission to display images of your child on their website, Facebook page, Yearbook, or other official documentation indefinitely (or until you have notified the Secretary of Chesterfield Youth Football & Cheer to rescind your permission). I give my permission to Chesterfield Youth Football & Cheer to use photographs and/or video images of my child in connection with the events and activities involving the Chesterfield Chargers. I consent to the use of his/her photograph in connection with the production, exhibition, distribution or other use of any photographs or motion video. I agree that his/her participation is voluntary, and without consideration or compensation. If, at any time, I do not want my child to participate in this activity I will notify the Secretary of Chesterfield Youth Football & Cheer in writing or by e-mail. Parent/Guardian Signature: Date:

CHESTERFIELD CHARGERS EQUIPMENT/REFUND POLICY I understand by signing this document I am agreeing to the following conditions: Up to May 15 th = Full Refund May 15 th to July 31 st = Refund less equipment fee below. o $75 for football o $100 for cheer August 1 st to End of the Season = NO REFUNDS WILL BE GIVEN. I agree that CYFC and the OMYFA cannot guarantee or cover costs associated with any untimely injury that results in my player/cheerleader sitting out the entire season. I also agree to return all Chesterfield Chargers property/equipment in my possession to the Equipment Manager at the announced Equipment Turn-In date following the season. In the event of a participant s resignation or expulsion I agree to return the equipment within 24 hours. This includes all football/cheer equipment issued to the participant during their participation period minus any garments they are allowed to keep. Failure to return Chesterfield Chargers issued property/equipment will result in legal action for which I will assume all associated legal costs. I will also be obligated to pay for lost, stolen, or damaged items due to neglect. I understand and agree to the Chesterfield Youth Football & Cheer Equipment/Refund policy. Parent/Guardian Signature: Date:

CONCUSSION Information Sheet This sheet has information to help protect your children or teens from concussion or other serious brain injury. Use this information at your children s or teens games and practices to learn how to spot a concussion and what to do if a concussion occurs. What Is a Concussion? A concussion is a type of traumatic brain injury or TBI caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells. How Can I Help Keep My Children or Teens Safe? Sports are a great way for children and teens to stay healthy and can help them do well in school. To help lower your children s or teens chances of getting a concussion or other serious brain injury, you should: Help create a culture of safety for the team. Work with their coach to teach ways to lower the chances of getting a concussion. Talk with your children or teens about concussion and ask if they have concerns about reporting a concussion. Talk with them about their concerns; emphasize the importance of reporting concussions and taking time to recover from one. Ensure that they follow their coach s rules for safety and the rules of the sport. Tell your children or teens that you expect them to practice good sportsmanship at all times. When appropriate for the sport or activity, teach your children or teens that they must wear a helmet to lower the chances of the most serious types of brain or head injury. However, there is no concussion-proof helmet. So, even with a helmet, it is important for children and teens to avoid hits to the head. Plan ahead. What do you want your child or teen to know about concussion? How Can I Spot a Possible Concussion? Children and teens who show or report one or more of the signs and symptoms listed below or simply say they just don t feel right after a bump, blow, or jolt to the head or body may have a concussion or other serious brain injury. Signs Observed by Parents or Coaches Appears dazed or stunned. Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent. Moves clumsily. Answers questions slowly. Loses consciousness (even briefly). Shows mood, behavior, or personality changes. Can t recall events prior to or after a hit or fall. Symptoms Reported by Children and Teens Headache or pressure in head. Nausea or vomiting. Balance problems or dizziness, or double or blurry vision. Bothered by light or noise. Feeling sluggish, hazy, foggy, or groggy. Confusion, or concentration or memory problems. Just not feeling right, or feeling down. Talk with your children and teens about concussion. Tell them to report their concussion symptoms to you and their coach right away. Some children and teens think concussions aren t serious or worry that if they report a concussion they will lose their position on the team or look weak. Be sure to remind them that it s better to miss one game than the whole season. To learn more, go to www.cdc.gov/headsup

Concussions affect each child and teen differently. While most children and teens with a concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your children s or teens health care provider if their concussion symptoms do not go away or if they get worse after they return to their regular activities. What Are Some More Serious Danger Signs to Look Out For? In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body and can squeeze the brain against the skull. Call 9-1-1 or take your child or teen to the emergency department right away if, after a bump, blow, or jolt to the head or body, he or she has one or more of these danger signs: One pupil larger than the other. Drowsiness or inability to wake up. A headache that gets worse and does not go away. Slurred speech, weakness, numbness, or decreased coordination. Repeated vomiting or nausea, convulsions or seizures (shaking or twitching). Unusual behavior, increased confusion, restlessness, or agitation. Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously. Children and teens who continue to play while having concussion symptoms or who return to play too soon while the brain is still healing have a greater chance of getting another concussion. A repeat concussion that occurs while the brain is still healing from the first injury can be very serious and can affect a child or teen for a lifetime. It can even be fatal. What Should I Do If My Child or Teen Has a Possible Concussion? As a parent, if you think your child or teen may have a concussion, you should: 1. Remove your child or teen from play. 2. Keep your child or teen out of play the day of the injury. Your child or teen should be seen by a health care provider and only return to play with permission from a health care provider who is experienced in evaluating for concussion. 3. Ask your child s or teen s health care provider for written instructions on helping your child or teen return to school. You can give the instructions to your child s or teen s school nurse and teacher(s) and return-to-play instructions to the coach and/or athletic trainer. Do not try to judge the severity of the injury yourself. Only a health care provider should assess a child or teen for a possible concussion. Concussion signs and symptoms often show up soon after the injury. But you may not know how serious the concussion is at first, and some symptoms may not show up for hours or days. The brain needs time to heal after a concussion. A child s or teen s return to school and sports should be a gradual process that is carefully managed and monitored by a health care provider. To learn more, go to www.cdc.gov/headsup You can also download the CDC HEADS UP app to get concussion information at your fingertips. Just scan the QR code pictured at left with your smartphone. Revised 5/2015 Discuss the risks of concussion and other serious brain injury with your child or teen and have each person sign below. Detach the section below and keep this information sheet to use at your children s or teens games and practices to help protect them from concussion or other serious brain injury. I learned about concussion and talked with my parent or coach about what to do if I have a concussion or other serious brain injury. Athlete Name Printed: Date: Athlete Signature: I have read this fact sheet for parents on concussion with my child or teen and talked about what to do if they have a concussion or other serious brain injury. Parent or Legal Guardian Name Printed: Date: Parent or Legal Guardian Signature: