Participants Name: ________________________

REGISTRATION FORM
Registration Number:__________
PLEASE PRINT CLEARLY

Participant's Name: (First)______________________ (Middle Initial) _____(Last)_______________________

Age: _______ Birthdate (mm/dd/yyyy): ________/________/________
Home address:______________________________________________________________Apt #___________
City:___________________________________ State:__________ Zip Code:_____________
DeKalb County Resident: ____Yes ___No If No, What County? ___________________________________
What school does the participant attend? _______________________________________________
Please advise of other siblings participating.
1. Name:___________________________________________age:________date of birth:________________
2. Name:___________________________________________age:________date of birth:________________
If in the same age category, are you requesting they be on the same team? _____Yes ____No
Father/Guardian: _____________________________________ Home Phone: (

)___________________

Address:_____________________________________________ Cell Phone: (

)____________________

Email:_______________________________________________ Work Phone: (

)____________________

Mother/Guardian:____________________________________

)___________________

Home Phone: (

Address:_____________________________________________ Cell Phone: (

Email: _______________________________________________ Work Phone: (

)______________________
)____________________

Emergency Contact: __________________________________ Relationship to child: ___________________

Home Phone: _____________________ Cell Phone:______________________ Work Phone: _______________
LEAGUE USE ONLY: Payment: CASH
MONEY ORDER #_____________
CREDIT/DEBIT
AMOUNT PAID: ___________receipt #____________ Copy of Birth Certificate: _____ Yes _____No

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Participants Name: ________________________

PLEASE READ AND INITIAL EACH STATEMENT

Parental/Guardian Consent
1. I/We the parents/guardians of the child named as a candidate for a position on a league team, hereby give
my/our approval to participate in any and all league activities. ________
2. I/We assume all risks and hazards incidental to such participation and activities, including transportation to
and from such activities. ________
3. I/We do hereby waive, release, absolve, indemnify, and agree to hold harmless this league (Kandy Crush
Kickers), the City the League resides, the organizers, sponsors, supervisors, participants, and persons transporting
my/our child to from activities, for any claim arising out of an injury to my/our child, whether the result of
negligence or for any other cause. ________
4. In consideration of being allowed to participate in the Program, I/We hereby release and forever discharge the
respectful officials, officers, employees, sponsors, organizers, supervisors, volunteers, participants and agents of
Kandy Crush Kickers' kickball program, ________________________________________________________
(PARK NAME)

from any and all claims, actions or causes of action of whatever kind and nature, including claims for property
damage, bodily injury or death, arising out of, or sustained as a result of, my/our/her participation in the Program
and all activities incidental to the Program. _____
5. I/We understand Kandy Crush Kickers League has the sole authority for placement of the Participant on a
team and that the administration fee ($30.00) paid on behalf of my/our daughter will not be refunded should the
assignment to a team not be of my/our choice. ________
6. I/We understand that the Kandy Crush Kickers League provides a partial uniform. It is my/our responsibility
to purchase the remainder of the uniform as required by the league. ________
7. I/We agree to return any issued equipment or uniform to the Kandy Crush Kickers League upon request. ____
8. I/We agree to participate in fundraiser(s). ________
9. I/We will furnish a copy of a certified birth certificate for the participant to Kandy Crush Kickers League prior
to the first practice of the season. ________
Parent/Guardian Signature: ___________________________________ Todays Date: _______________

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Participants Name: ________________________

GENERAL REGISTRATION POLICIES

1. The completion of this application DOES NOT guarantee you a spot in the kickball program. Once the staff
receives this information it will be processed within 2 weeks after the last registration. ________
2. Any participant may receive a refund of their membership fee minus the administration fee ($30.00 per child)
2 weeks after their registration date. After the 2 week grace period all funds will be NON-REFUNDABLE. All
refunds take approximately 25 business days to be processed. A money order will be mailed to the home address
provided on this application. ________
Parent/Guardian Signature: _____________________________________ Today's Date: _______________
PHOTOGRAPHY/VIDEO RELEASE
I/We, DO / DO NOT (circle one) give permission for my/our child to be included in photographs, and/or
videotape productions for the purposes of event sponsored publications, multimedia presentation, and for display
on a password protected website where the images may be made available for purchase. ________
Parent/Guardian Signature: _____________________________________ Today's Date: _______________
REGISTRATION FEE
The total cost of membership fee for the 2015 Kandy Crush Kickers Youth Kickball League year is $85.00. The
second sibling is $75. Your fee will go towards the participants' team jersey, socks, carry bag, field rental for
games and practices, field insurance, referees, equipment and awards. This does not cover the end of the season
event (TBD). I/We will participate in fundraiser(s) that will assist in the monetary donations for the season event.
________
A $3.00 service fee will be included in membership fee paid via credit/debit. ________
Parent/Guardian Signature: _____________________________________ Today's Date: _______________
WAIVER
I/We herby give my full consent to have a coach, team manager, athletic trainer, nurse, EMS Technician, medical
treatment facility and/or doctor of medical assistance and/or treatment and totally agree to be financially
responsible for the cost of such assistance and/or treatment. I fully understand treatment for injury will be based
on the information provided herein. I/We hereby EMS transportation of the participant to a medical treatment
facility should the individual listed considered it to be warranted. I recognize the possibility of physical injury
associated with kickball, and hereby release, discharge, and otherwise indemnify Kandy Crush Kickers Kickball
League, __________________________________, its affiliates, managers, and employees. ________
(Park Name)

Parent/Guardian Signature: _______________________________________ Today's Date: _____________

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Participants Name: ________________________

Player/Parent Code of Conduct:

The kickball league should be a fun and rewarding time for the players, parents, coaches, umpires, and
fans. Through kickball, the Kandy Crush Kickers Youth Kickball League (KCK) seeks to enhance the
physical, mental, and emotional well-being of every child that takes part. It is the Leagues express goal
that every player will be a better citizen, and have a greater chance for success in future endeavors, as a
result of their KCK. As such, KCK expects the highest degree of sportsmanship from its members. In
keeping with this philosophy, the following Code of Conduct has been adopted to better promote fairness,
teamwork, trust, good citizenship, sportsmanship, responsibility, and respect among the members of the
Kandy Crush Kickers League.
KCK strongly encourages the following:
Applaud effort on the field, regardless of the score.
Remember that the league exists for the players to learn and to have fun. Even though kickball is
competitive in nature, winning is of secondary performance.
Parents should be supportive of coaches. The coaches are volunteers giving of their time and often,
giving of their money in order to coach. Parents should be a positive role model that fosters respect of the
coaches among the players. Concerns about a players role on a team should be expressed to the coach in a
private setting, never in public.
Umpires are in training as well as the players. Coaches and parents should bear in mind that many of
our umpires are volunteers learning the skills of umpiring. All umpires will make mistakes occasionally,
but coaches and parents are expected to accord the umpires with the respect their position within the game
deserves.
Booing, taunting, refusing to shake another coachs and/or players hands after a game, or ridiculing
another player is not acceptable behavior.
Teach players that they have a responsibility to learn and to try their best. Effort leads to achievement
and respect.
Players will learn these values by the examples they see from those around them, and to this end, the
following rules will be strictly enforced:
Verbal abuse of an official, coach, player, or spectator, including obscene gestures, will not be tolerated.
The offender may be removed from the KCK fields at the discretion of an umpire or KCK board member.
Kickball is a game of interpretations, and as a result, disputes will occur from time to time. However, it is
important that players learn respect. All disputes that are taken up with the umpire will be handled in a
civil manner. Only managers may initiate such discussions with an umpire.
Coaches will refrain from complaining about perceived bad calls to players and fans.
All discussions will be held in conversational tones. Under no circumstances will a coach, fan, or player
yell at an umpire, coach, fan, or player. The lone exception to this rule is when a coach or player shouts to
another coach, player or teammate during the course of a play as part of that play.
Profanity is expressly forbidden at all times.
Alcoholic beverages and the use of illicit drugs are prohibited at all KCK games, including events outside
of ______________________________________.
(Park Name)

The use of tobacco products on the KCK fields and in the dugouts is prohibited.
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Participants Name: ________________________

Anyone removed from the KCK fields must leave all fields and the access roads to the fields. Such persons
may not remain in the KCK parking lot. Any infraction of the above rules will result in a report being
delivered to the KCK League Board for consideration of further action, as appropriate. First Offense:
Upon the reporting of a first offense by an individual, the Board of Directors, at a minimum, will provide a
written warning to the offender, detailing the consequences of future infractions. Depending upon the
severity of the infraction, nothing precludes the Board of Directors from banning a repeat offender from all
KCK League activities, including, but not limited to, practices and games, for a period of time deemed
appropriate by the Board of Directors. Second Offense: The Board of Directors may institute a wide range
of penalties for repeat offenders, beginning with the second offense, as deemed appropriate by the Board.
Such penalties include, but are not limited to:
1. A ban from participating in all KCK activities for a set period of time or number of games.
2. Severe violations can result in suspension from all KCK activities for the remainder of the current season
or tournament.
Third Offense: The Board of Directors may choose to apply any of the penalties prescribed for a second
offense. In the most extreme of circumstances, the KCK Board of Directors may hold a meeting to
determine whether or not the individual should be permanently banned from all future KCK activities. The
individual in question must receive a certified letter of such a hearing at least one week prior to the
meeting, and must be given the opportunity to speak at the meeting. Physical Abuse - Physical abuse of an
official, coach, player, or spectator will result in immediate expulsion from the KCK fields at the direction
of an umpire or a KCK board member. Anyone expelled for this reason may not return to the KCK fields
or participate in any KCK activity until the KCK Board of Directors approves. Any parent, fan, or player
who has been suspended or banned from league activities may petition, in writing, to the Board of
Directors for a review of the penalty. The petition should be delivered to the league president, and the
Board of Directors will meet as soon as reasonably possible to consider the petition. The aggrieved parties
will have the opportunity at the meeting to present their appeal.
PLAYER CODE OF CONDUCT
I hereby pledge to be positive about my youth kickball experience and accept responsibility for my
participation by following this Code of Conduct.
I will encourage good sportsmanship from fellow players, coaches and parents at every game and practice
by demonstrating good sportsmanship.
I will attend every practice and game that I can and will notify my coach if I cannot.
I will do my best to listen and learn from my coaches.
I will expect to receive a fair amount of playing time.
I will treat my coaches, other players, officials and fans with respect regardless of race, sex, creed, or
abilities, and I will expect to be treated accordingly.
I deserve to have fun during my baseball experience and will alert my parents and coaches if it stops
being fun!
I will encourage my parents to be involved with my team in some capacity because it is important to me.
I will do my very best in school.
I will remember that youth baseball is an opportunity to learn and have fun.

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Participants Name: ________________________

PARENT CODE OF CONDUCT

I will not force my child to participate in sports.
I will remember that children participate to have fun and that the game is for youth, not adults.
I will inform the coach of any physical disability or ailment that may affect the safety of my child or the
safety of others.
I will learn the rules of the game and the policies of the league.
I (and my guests) will be a positive role model for my child and encourage sportsmanship by showing
respect and courtesy and by demonstrating positive support for all players, coaches, officials and spectators
at every game, practice or sporting event.
I (and my guests) will not engage in any kind of unsportsmanlike conduct with any official, coach, player,
or parent such as booing and taunting, refusing to shake hands, or using profane language or gestures.
I will not encourage any behaviors or practices that would endanger the health and well-being of the
athletes.
I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence.
I will demand that my child treat other players, coaches, officials and spectators with respect regardless of
race, creed, color, sex or ability.
I will teach my child that doing one's best is more important than winning, so that my child will never feel
defeated by the outcome of a game or his/her performance.
I will praise my child for competing fairly and trying hard and make my child feel like a winner every
time.
I will never ridicule or yell at my child or other participants for making a mistake or losing a competition.
I will promote the emotional and physical well-being of the athletes ahead of any personal desire I may
have for my child to win.
I will respect the officials and their authority during games and will never question, discuss, or confront
coaches at the game field, and will take time to speak with coaches at an agreed upon time and place.
I will refrain from coaching my child or other players during games and practices, unless I am one of the
official coaches of the team.
Player/Parent Code of Conduct
My signature verifies that I have read, understand, and agree to abide by and agree to the consequences of
Kandy Crush Kickers Youth Kickball League guidelines on the Player Code of Conduct.
____________________________
(Printed name of player)

___________________________
(Signature of player)

______________
(Date)

My signature verifies that I have read, understand and agree to abide by and agree to the consequences of
the Kandy Crush Kickers Youth Kickball League guidelines on the Code of Conduct. I have also read and
discussed with my child participant the Player Code of Conduct and will do my best to positively encourage
my child to abide by its contents.
_____________________________
___________________________
_______________
(Printed name of parent/guardian)
(Signature of parent/guardian)
(Date)
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Participants Name: ________________________

ACKNOWLEDGMENT OF RISK AND HOLD HARMLESS AGREEMENT

I hereby acknowledge that I have voluntarily chosen to participate in the Kandy Crush Kickers kickball
program through _____________________________________________.
(Park Name)

I understand the risks involved in the program. I recognize that the program and its activities involves risk
of injury and I agree to accept any and all risk associated with it, including but not limited to property
damage or loss, minor bodily injury, severe bodily injury, and death. Furthermore, I recognize that
participation in the program involves activities and risks incidental thereto, including but not limited to,
transportation related to the program, games, competitions, training, practices, scrimmages, plays,
physical contact with other players, limited availability of medical assistance and the possible reckless
conduct of other participants. I am voluntarily participating in the program with the knowledge of the
risks involved and hereby agree to accept any and all inherent risks of property damage, bodily injury, or
death.
In consideration of my participation in the program and to the fullest extent permitted by law, I agree to
indemnify, defend and hold harmless Kandy Crush Kickers, its trustees, officers, directors, employees,
agents, volunteers and assigns from and against all claims arising out of or resulting from my participation
in the program. "Claim" as used in this agreement means any financial loss, claim, suit, action, damage or
expense, including but not limited to attorney's fees, attributable to bodily injury, sickness, disease or
death, or injury or destruction of tangible property including loss of use resulting there from. In addition,
I hereby voluntarily hold harmless Kandy Crush Kickers, its trustees, officers, directors, employees,
agents, volunteers and assigns from any and all claims, both present and future, that may be made by me,
my family, estate, heirs or assigns.
I hereby expressly agree to indemnify, defend, and hold harmless Kandy Crush Kickers, its trustees,
officers, directors, employees, agents, volunteers and assigns for any claim arising out of or incident to my
participation in the program, unless claim is caused by the sole negligence or willful misconduct of Kandy
Crush Kickers.
I also understand that Kandy Crush Kickers does not provide any medical or dental insurance or life
insurance to cover bodily injury, illness or death, nor insurance for personal property damage or loss, nor
insurance for liability arising out of my negligent acts or omissions; and I acknowledge that I am
completely responsible for my own insurance to cover these expenses.
I further understand that this assumption of risk and hold harmless is intended to be as broad and
inclusive as permitted by the laws of the State of Georgia and that if any portion hereof is held invalid, I
agree that the balance shall, notwithstanding, continue in full legal force and effect.

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Participants Name: ________________________

I agree that this acknowledgment of risk and hold harmless is effective for as long as I participate in the
program.
I have read and understand this acknowledgement of risk and hold harmless.
Participant's Name: _______________________Signature:___________________________Date: _________
IF THE PARTICIPANT IS UNDER THE AGE OF 18, THE SIGNATURE OF A PARENT IS REQUIRED.
Parent Name: ____________________________ Signature: ___________________________

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