Youth Sports Organization Waiver

youth sports waiver form

CHILDS NAME*

First

Last

CHILDS DATE OF BIRTH*

GUARDIANS FULL NAME*

Prefix

First

Last

PHONE NUMBER*

EMAIL*

GUARDIANS ADDRESS*

CITY, STATE*

ZIP CODE*

INCOME

SINGLE PARENT?

AGE / DOB

EMERGENCY CONTACT NAME*

EMERGENCY CONTACT NUMBER*

*I have read and agree to the terms & conditions along with the code of conduct

Media Release:

I hereby grant permission for my child’s image and likeness to be used in any and all media, including but not limited to photographs, videos, and social media posts, for the purpose of promoting the youth sports organization.

"I hereby grant permission for my child’s image and likeness to be used in any and all media, including but not limited to photographs, videos, and social media posts, for the purpose of promoting the youth sports organization."

Assumption of Risk and Release of Liability:

I understand that participation in youth sports activities involves inherent risks, including but not limited to injury, illness, and even death. I voluntarily assume all risks associated with my child’s participation in these activities.

"I hereby release and hold harmless ShockTown’s YES Community Program, Inc., its officers, directors, employees, volunteers, and agents from any and all liability, claims, demands, or causes of action whatsoever arising out of or related to my child’s participation in these activities, including any incidents or injuries that may occur."

Medical Treatment Authorization:

In the event of an emergency, I authorize ShockTown’s YES Community Program, Inc. to seek medical treatment for my child, including but not limited to first aid, transportation to a medical facility, and administration of medication. I understand that every effort will be made to contact me prior to seeking medical care, but in the case of an emergency, immediate action may be taken.

Important Notice: ShockTown’s YES Community Program, Inc. is not a daycare, summer camp, or licensed child-care facility. The program is not licensed by the state and does not offer child-care services. The program provides structured sports, leadership, and safety education activities to youth participants.

"Parents/guardians acknowledge that the program is not a substitute for daycare or after-school care services, and that the organization assumes no liability for child care or supervision outside of the scheduled program activities."

Program Participation:

Participation in the program is voluntary, and I am aware that my child will be involved in physical activities that may include sports and athletic exercises. I agree to ensure my child is physically capable of participating and has received medical clearance if necessary.

Emergency Procedures:

I acknowledge that I have provided updated emergency contact information and agree to inform the program if any changes occur to this information.

CODE OF CONDUCT

Rules for Kids

Respect Others: Treat teammates, coaches, and mentors with kindness and respect. Bullying, teasing, or any form of disrespect is not allowed.
Follow Instructions: Listen carefully to coaches and mentors and follow directions during all activities.
Wear Appropriate Sports Attire: Wear comfortable athletic clothing and closed-toe sports shoes suitable for physical activities. Avoid jeans, sandals, or other non-sports attire.
Stay Safe: Use equipment properly, stay within designated areas, and follow safety guidelines at all times.
Be Inclusive: Encourage and support your teammates. Avoid excluding others from activities or groups.
Practice Good Sportsmanship: Win or lose, be gracious. Celebrate achievements and learn from mistakes.
Participate Actively: Give your best effort during all activities and stay engaged.
No Use of Electronics: Phones and devices should be kept away during activities unless given permission by staff.
Be On Time: Arrive promptly for all sessions and activities.

Rules for Parents

Be Supportive: Encourage and support your child and other participants in a positive manner. Avoid criticizing or putting pressure on them.
Respect Staff: Treat all coaches, mentors, and staff with respect. Follow their instructions and guidelines for the program.
Model Good Behavior: Set an example of sportsmanship and respect for all children, staff, and other parents.
Dress Comfortably and Respectfully: If attending or volunteering, wear casual or athletic attire that allows you to move easily and aligns with the spirit of the program.
No Coaching from the Sidelines: Allow the program staff to lead activities. Refrain from instructing your child during sessions.
Be Punctual: Ensure your child arrives on time and is picked up promptly at the end of each session.
Communicate Concerns Privately: If you have questions or concerns, address them privately with the program staff, not during sessions.
Adhere to Program Policies: Follow all program policies, including attendance, dress code, and safety rules.
Avoid Distractions: Respect the focus of the program by avoiding loud conversations or interruptions during activities.

Consequences for Breaking Rules

• For Kids: Verbal warning → Temporary removal from activity → Parent notification → Dismissal from the program (if behavior persists).
• For Parents: Verbal warning → Private discussion with staff → Removal from program events (if behavior persists).

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youth sports waiver form

Media Release:

Assumption of Risk and Release of Liability:

Medical Treatment Authorization:

Program Participation:

Emergency Procedures:

CODE OF CONDUCT

Rules for Kids

Rules for Parents

Consequences for Breaking Rules

SUPPORT

ABOUT US

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our vision

ShockTown’s YES Community Program, Inc. is a registered 501(c)(3) nonprofit organization. Contributions are tax-deductible to the extent permitted by law.”