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Youth Registration Form
File Size:
1008 kb
File Type:
pdf
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Sports League Registration
Sports League Informa
tion
*
Indicates required field
Participating Sport
*
Choose One
Indoor Soccer - Beginner
Indoor Soccer - Advanced Player
Youth's Jersey/Shirt Size
*
Choose One
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult 1X
Adult 2X
Youth Information
Youth's Name
*
First
Last
Youth's Gender
*
Choose One
Male
Female
Do not disclose
Youth's Date of Birth (MM/DD/YYYY)
*
Youth's Age
*
Youth's School Name
*
Youth's School Grade
*
Primary Contact Information
Primary Contact's Name
*
First
Last
Primary Contact's Relationship to Youth
*
Choose One
Mom
Dad
Step Mom
Step Dad
Grandparent
Aunt/Uncle
Foster Parent
Legal Guardian
Other
Primary Contact's Phone Number
*
Primary Contact's Email Address
*
Primary Contact's Physical Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact Information
Emergency Contact's Name (Other Than Primary Contact)
*
First
Last
Emergency Contact's Relationship to Youth
*
Choose One
Mom
Dad
Step Mom
Step Dad
Grandparent
Aunt/Uncle
Foster Parent
Family Friend
Other
Emergency Contact's Phone Number
*
Emergency Contact's Email Address
*
Statistical Data
BGCCB is a 501(c)(3) non-profit organization. The following information is necessary for our records and the funding our organization receives. The answers you provide are kept completely confidential.
Youth's ethnicity
*
Choose One
Hispanic, Latino
White, Caucasian
Black, African American
Asian
Native Hawaiian/Pacific Islander
American Indian/Alaska Native
Bi/Multi Racial
Does the youth participate in the school lunch program
*
Choose One
Free Lunch
Reduced Lunch
Not Eligible
Does youth live in a single-parent household?
*
Choose One
Yes
No
What is your annual household income
*
Choose One
$0-$10,000
$10,001-$20,000
$20,001-$30,000
$30,001-$40,000
$40,001-$50,000
$50,001-$62,999
$63,000 and up
Known Health Concerns
Please list any health concerns BGCCB needs to be aware of during games & practices (i.e. asthma, heart conditions, etc.)
Known health concerns (N/A if not applicable)
*
How did you hear about us?
Choose all that apply
*
Family or Friend
Flyer or Phone
Email or Newsletter
Social Media or Website
TV Advertisement
Other
Acknowledgment
I approve of my child’s application for membership and/or participation in Boys & Girls Clubs of the Coastal Bend (BGCCB) sports leagues. I will not hold the members of the Board, staff or leaders responsible for injury, which may occur while participating in the BGCCB activity mentioned above. I understand that I am responsible for transporting my child to and from events. I also acknowledge that medical insurance is not provided through BGCCB.
PLEASE NOTE:
1.
Players who have unpaid balance from previous BGC leagues will not be allowed to play until payment is made in full.
2. Sports League f
ees are NON-REFUNDABLE due to equipment cost, uniforms, Referees, and administrative fees.
3. BGCCB has a NO REFUND policy.
Electronic Signature (Sport League Registration)
*
Date (MM/DD/YYYY)
*
PARTICIPANT RELEASE OF LIABILITY
Youth's Name
*
First
Last
In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:
The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLI-GENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately, and
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Boys & Girls Clubs of the Coastal Bend, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
GENERAL MEDIA & PHOTOGRAPHIC RELEASE
The Boys & Girls Clubs of the Coastal Bend as well as Boys & Girls Clubs of America frequently use photographs information from surveys, and quotes from the members to publicize programs. Your permission is needed to use photos, testimonies, and videos, including information from surveys and/or quotes of your child(ren) on our web site (www.bgccb.org) in informational brochures, social medina and in news articles. I give my consent for any photographs or reproductions thereof (while he/she is engaged in Club-related activities) and in which my child(ren) appear or quotes my child(ren) give to be used in anyway the Club may choose including grant/publicity/fundraising purposes
General Media & Photographic Release
*
Choose One
Yes
No
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE
(UNDER AGE 18 AT TIME OR REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liability incidents to my minor child's involvement or participation in these programs as provided above. EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
The Boys & Girls Club of The Coastal Bend athletics programs provide boys and girls of all ages, regardless of their athletic ability, the opportunity to learn new skills and develop self-esteem, teamwork and leadership skills. Sports programs emphasize fun and full participation for every youth. Coaches and spectators are expected to demonstrate good sportsmanship and positive support for all players and officials.
Electronic Signature (Release of Liability)
*
Date (MM/DD/YYYY)
*
Indoor Soccer Rules
RULES/GUIDELINES:
TEAM ROSTER
: Minimum of 4 players, maximum of 8 players. All players must play at least 50% of the game. No goalkeeper
TIME LIMIT:
two 15-minute halves (ages 6-8), two 20-minute halves (ages 9+), 3-minute halftime. Running clock except for injuries and at the discretion of the referee.
GOAL BOX:
a designated area 5x11ft will be boxed off in front of each goal. (8u will use the free throw top of the key arc) A ball may not be played in this area by either an attacking or defending player. If an attacking player plays the ball in this area, a goal kick is awarded. If a defending player plays the ball in this area, a goal may be award if “
In the opinion of the referee
”, the ball would have entered the goal had the defender not played it. If “
in the opinion of the referee
”, the ball would have gone wide of the goal, a corner kick will be awarded.
SHINGUARDS, SHOES, and SHIRTS:
must be worn at all times. Jewelry should be removed.
Shin guards are mandatory. They should
be covered entirely by the stockings
Be made of rubber, plastic or a similar approved material
provide a reasonable degree of protection
Indoor Soccer or gym shoes are mandatory
Absolutely no cleats are to be worn in the gym
SUBSTITUTIONS
: may be made “on the fly”. Free substitutions are allowed throughout the game. The player leaving the field must have both feet off the field before another is allowed to enter the field.
KICKOFFS
: referee will signal the start of play. Kick does not have to go forward.
Opponent Distance:
10ft for all free kicks, kick-ins and restarts.
NO SLIDE TACKLES:
if the violation is serious enough or warning is not followed, the player may be sent off. Sliding to block a pass/shot or to keep a ball in play is allowed if no other players are in the vicinity. Players go to ground at their own risk. Contact does not have to be made in order for a foul to be called.
THREE LINE PASS: (10u and above)
a ball may not cross the defensive zone, midfield line and attacking zone in the air without being touched by another player. The ball does not have to touch the ground in order for a three line pass to be called. The restart will be a direct free kick from the middle of the defensive zone line.
SOCCER BALLS:
Size 4 Futsal will be used during all games
Any minor injuries involving blood must be covered by a Band-Aid or other suitable covering. Referee must stop the game and the player must leave the field until the wound is covered.
FOULS:
always results in a direct kick
. Any foul with 10 feet of the goal area may be moved back to allow proper distance to be given by the defending team. Taken from the spot of the infringement or on the line of the penalty area nearest the infringement
GOAL KICKS:
ball placed anywhere on the goal box. It is not allowed to score directly from a kick-in: the goal is valid only if someone else touches the ball before it enters in goal.
NO THROW-INS:
ball placed on the touchline and kicked to a teammate. **Kick-ins are indirect**
CORNER KICKS:
no restrictions
HEADING:
U8 & U10 will not be allowed to head the ball. U12 and above may head the ball as long as they are not playing in a dangerous manner
OFFSIDE:
There are no offside violations.
Ceiling:
If the ball hits the ceiling or other object, the team that did not touch the ball last restarts play with a kick-in from the nearest point on the touchline.
Goal scored:
A goal is scored when the whole of the ball passes over the goal line, between the goalposts and under the crossbar, provided that no infringement of the Futsal Laws of the Game has been committed previously by the team scoring the goal.
Fouls and Misconduct
Direct Free Kicks:
When a player kicks or attempts to kick an opponent, slide tackles an opponent or slides with an opponent near (automatic yellow card/caution), jumps at an opponent, charges at an opponent, strikes or attempts to strike an opponent, pushes an opponent, holds an opponent, spits at an opponent, or handles the ball deliberately.
Yellow Card / Caution:
The offending player is shown a yellow card. If a player earns two yellow cards in a match, he is shown a red card.
Yellow Card Offences:
Unsporting behavior • Dissent by word or action • Persistent infringement of the Futsal Laws of the Game • Delaying the restart of play • Failure to respect the required distance when play is restarted with a corner kick, free kick or kick-in (defending players) • Entering or re-entering the pitch without the referees’ permission or in contravention of the substitution procedure • Deliberately leaving the pitch without the referees’ permission
A substitute is cautioned if he commits any of the following four infringements: • Unsporting behavior • Dissent by word or action • Delaying the restart of play • Entering the pitch in contravention of the substitution procedure
Red Card / Ejection:
The offending team plays down for two minutes unless scored upon before the two-minute penalty expires. The offending player serves a minimum one-match suspension.
Sending-off offences A player or substitute is sent off if he commits any of the following seven offences: • Serious foul play • Violent conduct • Spitting at an opponent or any other person • Denying the opposing team a goal or an obvious goal scoring opportunity by deliberately handling the ball • Denying an obvious goal scoring opportunity to an opponent moving towards the player’s goal by an offence punishable by a free kick or a penalty kick • Using offensive, insulting or abusive language and/or gestures • Receiving a second caution in the same match A substitute is sent off if he commits the following offence: • Denying a goal or an obvious goal scoring opportunity
CAUTIONS, EJECTIONS:
players may be asked to sit out if a caution-able offense has been committed or ejected from the game if the violation is more serious.
Specialty Rules:
U10 will play the full length of the court. U8 will be the only division playing free throw line to free throw line
Kick-ins & goal kicks are indirect
Sliding for a ball is allowable if no players are in the vicinity of the sliding player. A player does not have to make contact for a sliding foul to be called.
Tie games will go to a 4-minute golden goal overtime. If the game is still tied at the end of 4-minutes, the result of the match will be considered a draw.
I have completely read and understand the rules put forth by the Boys & Girls Clubs of the Coastal Bend.
Electronic Signature (Rules)
*
First
Last
Date (MM/DD/YYYY)
*
COVID-19 Release
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization
. COVID-19 is extremely contagious
and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Boys & Girls Clubs of The Coastal Bend, Inc. (Club) has put in place preventative measures to reduce the spread of COVID-19; however, the Club
cannot guarantee
that you and/or your child(ren) will not become infected with COVID-19. Further,
attending the Club and/or participating in Club sports leagues could
increase
your risk and/or your child(ren)’s risk of contracting COVID-19.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and/or I may be exposed to or infected by COVID-19 by participating in any Club programs and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I and/or my child(ren) may experience or incur in connection with mine and/or my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and/or on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.
Youth's Name
*
First
Last
Electronic Signature (COVID-19 Release)
*
First
Last
Date (MM/DD/YYYY)
*
By pressing submit, you are stating that you have completed and acknowledged the following documents: Sports League Registration, Rules, and COVID-19 Release.
Submit
For more information call
361-853-2505
or email
athletics@bgccb.org
Home
About Us
Boys & Girls Clubs of America
Our Team
Our Board
Careers
Policies
Our Clubs
Registration
>
Flour Bluff - Summer
Greenwood - Summer
Early Learning Center
Greenwood - Spring
Flour Bluff - Fall
Ingleside - Fall
Youth Athletics
MyFuture Login
Events
Beads, Bets, & Beignets
Serve It Forward Pickleball Champions
Donate
Wish List
Kayak Raffle Payment