Amenity Athletics Spring Basketball 2022

* Required Fields

Fee: $95.00Payment MUST be made at time of Registration. Registration Fee includes award and jersey

Player Information- Payment REQUIRED for Registration

*Player First Name

*Player LAST NAME

*Gender: M for Male, F for Female

*Player's Date of Birth

mm/dd/yyyy

*Age as of January 1, 2022

*Division

*Community

Practice Community if Different than Residence

*Shirt Size

Years of experience

Skill level

Primary Parent/Guardian Information

*First and Last Name

*Email Address: Guardian 1, Primary Contact

*Cell Phone

Second Parent/Guardian Information

First and Last Name

Email Address: Guardian 2

Cell Phone

Address and Community Information

*Street Address

City

State

Zip Code

Coach and Player Request- One Each Only Please

Coach Request

Player Request- ONE ONLY

Don't type in this field

HEAD COACH STATUS

Consider Volunteering Today.

We need Coaches! Volunteer as Head Coach and receive a discount/refund.

Thank you for Volunteering!

*COACHING STATUS

Emergency Contact Information

*Primary Emergency Contact, First and Last Name

*Relationship

*Cell Phone

*Emergency Email Address 1

Secondary Emergency Contact, First and Last Name

Relationship

Cell Phone

Emergency Email Address 2

Participant Medical Information

Hospital/Clinic Preference

Physician's Name

Physician's Phone Number

Insurance Company

Insurance Policy Number

Medical Conditions/Allergies

Waiver and Photo Release

GENERAL RELEASE AND WAIVER OF LIABILITY

Pursuant to Florida Statute 744.301:

NOTICE TO THE MINOR CHILD’S
NATURAL GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF

Bartram Springs CDD, Brandy Creek CDD, Celestina, Heritage Landing CDD, King and Bear, Aberdeen CDD, Turnbull Creek CDD, Durbin Crossing CDD, Southaven CDD, Trout Creek CDD, Rivers Edge 1 and Rivers Edge 2, Cimerrone CDD, Samara Lakes CDD, Shearwater CDD

USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM

Bartram Springs CDD, Brandy Creek CDD, Celestina, Heritage Landing CDD, King and Bear, Aberdeen CDD, Turnbull Creek CDD, Durbin Crossing CDD, Southaven CDD, Trout Creek CDD, Rivers Edge 1 and Rivers Edge 2, Cimerrone CDD, Samara Lakes CDD, Shearwater CDD

IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND

Bartram Springs CDD, Brandy Creek CDD, Celestina, Heritage Landing CDD, King and Bear, Aberdeen CDD, Turnbull Creek CDD, Durbin Crossing CDD, Southaven CDD, Trout Creek CDD, Rivers Edge 1 and Rivers Edge 2, Cimerrone CDD, Samara Lakes CDD, Shearwater CDD

HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

I acknowledge and understand that participation in the Program has certain inherent risks, including, but not limited to, significant changes in the Participant’s health, injury or even death to the Participant, and on behalf of the Participant, I agree to assume and accept sole responsibility for all risks related to participation in the Program, including, but not limited to, the risks mentioned above and/or damage to, loss or theft of property, or other loss or damage of any nature.

I acknowledge on behalf of Participant that the District recommends that the Participant consult a physician prior to engaging in the Program. I hereby certify that the Participant is physically and mentally capable of participating in the Program and that the Participant is not under any kind of medical treatment nor has any mental or physical condition that would prevent Participant from participating in the Program.

On behalf of Participant, I hereby indemnify, waive, release, hold harmless, and forever discharge the District and its present, former and future Supervisors, agents, officers, employees and staff, and its employees, agents and staff, and Vesta Property Services, Inc., and its employees and agents (collectively, the “Indemnitees”), of and from any and all claims, demands, expenses, debts, contracts, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, that I ever had or may have, arising from or in any way related to participation in the Program. I further agree to pay all expenses, including court costs and attorney fees, incurred by the Indemnitees in investigating and/or defending a claim or lawsuit related to the Participant’s participation in the Program. This waiver of liability does not apply to any act of gross negligence, or intentional, willful or wanton misconduct by the Indemnitees. However, I agree that nothing herein shall constitute or be construed as a waiver of the District’s limitations on liability contained in section 768.28, Florida Statutes.

This General Release and Waiver of Liability is binding upon myself, my spouse, heirs, executors, administrators, legal representatives, successors and assigns. This General Release and Waiver of Liability supersedes any prior written and/or oral agreements or representation made with respect to the subject matter contained herein. The provisions of the General Release and Waiver of Liability will continue in full force and effect even after the termination of the Program. The provisions of this General Release and Waiver of Liability may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of the District, and Vesta Property Services, Inc., altogether, and the party whose signature appears below. Nothing herein shall alter the Participant’s rights or obligations under the Policies and Fees for the Amenity Facilities and/or related documents.

If Participant is a minor child, I certify that I am the Participant’s parent and/or legal guardian and that I am legally authorized to sign this General Release and Waiver of Liability on behalf of the Participant. Further, in the event that I cannot be reached, I authorize and direct the Instructor to seek emergency treatment, as required, and to transport the Participant to the appropriate medical facility in the event that the urgent/emergency care is necessary. The medical facility and its medical staff have my authorization to provide any treatment that a physician deems necessary for the well being of the Participant. I understand that the resulting expenses will be my responsibility. I understand and acknowledge that the District and Vesta Property Services, Inc. are not responsible for providing such treatment or transportation and I hereby agree to hold the District, its supervisors, agents, officers and staff and Vesta Property Services, Inc., harmless for any acts or omissions related to emergency medical transportation and/or treatment resulting from myself or my child’s participation in the Program. I further agree to pay all expenses, including court costs and attorney fees, incurred by the Indemnitees in investigating and/or defending a claim or lawsuit resulting from or related to the emergency medical transportation and/or treatment of the Participant. I am of lawful age and legally competent to sign this General Release and Waiver of Liability. I have read and understand the terms of this General Release and Waiver of Liability, and I have willingly signed it as my own free act.

PHOTO RELEASE:

I give my permission to

Bartram Springs CDD, Brandy Creek CDD, Celestina, Heritage Landing CDD, King and Bear, Aberdeen CDD, Turnbull Creek CDD, Durbin Crossing CDD, Markland CDD, Trout Creek CDD, Rivers Edge 1 and Rivers Edge 2

and Vesta Property Services to use, without limitation or obligation, photographs, film footage or tape recordings that may include my child’s image or voice for purposes of promoting or interpreting

Bartram Springs CDD, Brandy Creek CDD, Celestina, Heritage Landing CDD, King and Bear, Aberdeen CDD, Turnbull Creek CDD, Durbin Crossing CDD, Southaven CDD, Trout Creek CDD, Rivers Edge 1 and Rivers Edge 2, Cimerrone CDD, Samara Lakes CDD, Shearwater CDD

and Vesta Property Services programs.

*Waiver Confirmation

I have read and agree with the waiver.

Payment and Refund Policies- Payment REQUIRED at time of Registration

Payment is through Paypal- all major credit cards accepted, electronic checks or your Paypal account. You DO NOT need a Paypal account to make your payment.

*Payment Policy

Payment must be made at time of registration or the registration will be deleted.

REFUNDS WILL ONLY BE ISSUED BY VESTA THROUGH PAYPAL.

*Refund Policy

A $25.00 service charge will be deducted from any refund that Vesta is not directly responsible for.

Thank you for choosing Amenity Athletics!

How did you hear about this program?

The Following is REQUIRED for Head Coach ONLY.

If you are NOT applying for Head Coach, please proceed to the check-out and re-enter your email to receive a registration confirmation.

Head Coach ONLY.

Head Coach Refund will be issued to you once the Athletic Director has chosen Head Coaches and the Required Background Check has been cleared and the Child Safety Training has been completed.

The $25.00 Head Coach Refund will be issued by VESTA to the Credit Card you provided for the Registration fee through PayPal.

Thank you for Volunteering!

Head Coach Background Check Authorization

In connection with my suitability for employment with Vesta Property Services, (herein “Client’) or if employed, I understand that prior to or at any time after my employment commences a consumer report may be requested for employment/volunteer purposes from Protect Youth Sports, Inc.,(herein: “Protect Youth Sports”) from public records including; but not limited to, Social Security number, motor vehicle operation history/driving records, workers’ compensation information and criminal history to the extent permitted by law from various local, state, and federal agencies. Further, I understand that an Employment Credit Report may be requested. Finally, I understand that an Investigative Consumer Report may be requested and, as required under §606(a)(1) of the federal Fair Credit Reporting Act (FCRA), IS U.S.C. §1681 et seq., I understand that this Report will include information as to my character, general reputation, personal characteristics, mode of living, work habits, performance, experience, along with reasons for termination of past employment, whichever are applicable, obtained through personal interviews with associates who have knowledge concerning such items of information.

I VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR PAST EMPLOYER OR SUPERVISOR, COLLEGE OR UNIVERSITY OR OTHER INSTITUTION OF LEARNING, ADMINISTRATOR, LAW ENFORCEMENT AGENCY, STATE AGENCY, LOCAL AGENCY, FEDERAL AGENCY, CREDIT BUREAU, PRIVATE BUSINESS, MILITARY BRANCH OR THE NATIONAL PERSONNEL RECORDS CENTER, PERSONAL REFERENCE, AND/OR OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINAL HISTORY, MOTOR VEHICLE HISTORY/DRIVING HISTORY, SOCIAL SECURITY NUMBER, EARNINGS HISTORY, CHARACTER, GENERAL REPUTATION, MODE OF LIVING,AND EMPLOYMENT (INCLUDING REASONS FOR TERMINATION), CREDIT HISTORY, CREDIT CAPACITY, OR CREDIT STANDING OR ANY OTHER INFORMATION REQUESTED BY PROTECT YOUTH SPORTS DEEMED PERTINENT TO MY EMPLOYMENT.

In accordance with the FCRA and applicable state laws, I understand that I have the right to request a complete and accurate disclosure of the nature and scope of the investigation requested. Further, I am entitled to know if employment is denied because of information obtained by my prospective employer from a Reporting Agency. If so, I will be so advised in writing and be given the name, address and toll free number of the agency, a statement that the action was based in whole or in part on information contained in the Report, and written notice that I have the right (i) if I request, to obtain within sixty days a free copy of the Report from the Reporting Agency (under no circumstances shall such cost exceed the actual costs of duplication), and from any other Consumer Reporting Agency which compiles and maintains files on consumers on a nationwide basis; and, (ii) to dispute the accuracy or completeness of any information in a consumer report furnished by the Reporting Agency. I understand that upon my request with reasonable notice and after furnishing proper identification, Protect Youth Sports’ trained personnel will provide me with investigative information in my file during normal business hours in person or upon written request, by certified mail to a specified addressee, or telephone as permitted by law. Further, I understand that should I wish to review my file in person; I am permitted to be accompanied by one other person of my choosing who shall furnish reasonable identification and if requested, Protect Youth Sports will provide a written explanation of any coded information contained in my file. I understand that Protect Youth Sports is a Consumer Reporting Agency and it is Protect Youth Sports’ policy to not be involved in or make hiring decisions or recommendation.

Protect Youth Sports’ privacy policy limits the information it provides to the client named herein, however I hereby authorize the client to share such information with parties in interest who have a “need to know” such information to protect them and their employees. Protect Youth Sports does not sell or otherwise provide any of the information found in its background investigations to any other party other than the client.

Background Confirmation

I have read and authorize a Background Check.

Required Head Coach Contact and Background Check and Child Safety Training

COACHES: Follow the link to complete the REQUIRED BACKGROUND CHECK and Child Safety Training:

http://opportunities.averity.com/AmenityAthletic

First Name

Last Name

Head Coach Email Address

Phone Number

Shirt Size

Head Coach Code of Conduct

Head Coach Code of Conduct

With regard to my players: I believe that my role as a coach is to contribute to the overall success, physical, and athletic growth of the player through participation in soccer.
I will endeavor to be a good instructor and a positive role model for my players.

I believe that the score of a game comes second to the safety and welfare of all my players.

I will endeavor to put winning in its proper perspective.

I am responsible for understanding and competing within the letter and the spirit of the Laws of the Game.

I will teach my players to understand and play within the letter and spirit of the Laws, as well.

With regard to opposing teams: I believe that the way my team conducts itself can also have an influence, for better or worse, on those we compete against.

I will endeavor to make my team a positive role model.

I will not coach, nor allow my players to play, with intent to cause injury to opposing players.

Neither I nor my players and spectators will display hostile behavior towards opposing players.

I will emphasize winning without boasting and losing without bitterness.

With regard to Referees:

I believe that Referees, just as coaches and players, are attempting to do their best.

I will instill in my players and spectators a respect for that fact.

I understand that my attitude can influence my players and spectators.

I will display a controlled and undemonstrative attitude toward Referees at all times.

Neither I nor my players and spectators will address a Referee before, during or after the game in a demeaning fashion.

Coaches are responsible for the conduct of their players and the spectators on their side of the field, specifically as it relates to the referee, coaches, players and spectators on the other team. Verbal and/or physical abuse will not be tolerated. If players conduct is not in the spirit of recreational soccer the referee can have the player leave the game for a cooling off period (length-determined by the referee). The same conduct rule applies to spectators. If the cooling off period does not resolve the problem, the spectator may be asked to leave the field. If a coach approaches a referee or steps on to the field to challenge a call, they will be asked to leave the game and the incident will be reviewed.

A review board consisting of (ASG Athletic Director, ASG Vice President, and 1 resident from each Bartram Springs and Heritage Landing) will review any incidents and recommend and/or enforce any/all disciplinary actions. I have read the above Code of Conduct and understand the enforcement and possible consequences for any infractions.

Code of Conduct Confirmation

I have read and agree with the Coaches Code of Conduct.

Total Due:

$

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