REGISTRATION FORM

Physical Form

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Registration Form

Participant's Name*

Sex*

Street Address / Town / City

Postcode / Zip

Date of Birth*

Age

Grade

School Attending

Parents / Guardian Name:*

Relationship:*

Parents / Guardian Name:

Relationship:

Phone

Parent's Signature*

Medical Information and Points of Contact

Emergency Contact:*

Relationship:*

Phone*

Alternate Phone

Alternate Contact:

Relationship:

Phone

Alternate Phone

Physican Name

Phone

Please list any medical conditions or medications for which your child is under a physician's care:

Please list any allergies your child has:

List any activities participant is unable to participate:

***Please understand only persons listed as a Parent, Guardian, or Emergency Contact will be allowed to pick up your child from any function or event (including practices, meets, training sessions, and other team meetings) unless otherwise communicated to a coach or administrator with Deland Lightning Bolts Track & Field Club.

Parent's Signature*

Splitter

Participant Consent and Release

I (or my child) am voluntarily participating in the program, class or event designate above. In return for the opportunity to participate, I voluntarily for myself (or my child) waive, release, indemnify and hold harmless Deland Lightning Bolts Track & Field Club and it's officers from any liabilities, claims, damages, injuries, losses and expenses including reasonable attorney fees and cost whatsoever, including those for personal injury, death or property damage, which may arise from or in connection with participation with this program, class or event.

I understand that I am solely responsible for transporting or arranging transportation for my child to all practices, meets, training sessions, and other team events.

Initials*

If this registration is for one of the minor children, I hereby consent to emergency treatment and transportation of my minor child for an condition which may arise during, from or in connection with participation in this program, class or event and I shall be responsible for the payment of all cost associated with suck emergency treatment or transportation.

Initials*

Further, I hereby give permission to Deland Lightning Bolts Track & Field Club to use any photographs taken by its officers or agents of either me or child during participation in this program, class or event. I agree such photographs shall be the property of Deland Lightning Bolts Track & Field and i am not entitled to compensation of any kind for the use of such photographs.

Initials*

I / We understand that Deland Lightning Bolts Track & Field Club is a 501c3 Non-Profit Organization. All coaches are volunteers and not paid. All cost for meets, uniforms, and associated fees are estimated based upon recent experience and vendor information provided to DLBTF. All funds collected are designated for Athlete Uniforms, Meet Entries, Club Participation Fees, Insurance, Facility Usage, Training Equipment Maintenance and Replacement. DLBTF has the right to close or to terminate registration and to change fees and requirements when necessary. This release shall remain in effect until cancelled in writing.

Parents Printed Name / Signature*

Date Field*

Parents Printed Name / Signature*

Date Field

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GENERAL RELEASE AND WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

Please read carefully. This is a release of legal rights.

Name of Minor Participant

DOB

In consideration of being allowed to participate in any way with Deland Lightning Bolts Track & Field and or being permitted to enter for any purpose and restricted area (defined as any area where admittance to the general public is prohibited), I, the parent and / or legal guardians of the minor named above, agree to assume all risk of any kind of injury or damage my child may receive or sustain as result of participation, including property loss, property damage, personal injury, or death

By my signature below I acknowledge my understand of the release and hold harmless and agree and confirm that:

As the parent / guardian, it is my responsibility to instruct the minor participant if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. The above named minor may, during the course of the program, participate in all the activities at Deland Lightning Bolts Track & Field, including but not limited to, the following activities: health-related fitness, body awareness, lead-up events, and sports. I grant permission for the above-named minor to receive medical treatment for any and all injuries and illness sustained or experienced during his/ her participation in the Deland Lightning Bolts Track & Field activities, included but not limited to emergency first aid, and emergency transport to a medical facility.

I KNOWINGLY AND FREELY ASSUME ALL RISKS, BOTH KNOWN AND UNKNOWN, AND HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS, ON BEHALF OF MYSELF, THE ABOVE NAMED MINOR, OUR HEIRS, ASSIGNS, AND NEXT OF KIN(COLLECTIVELY, THE "RELEASERS"), Volusia County Public Schools, City of Deland Recreation, DELAND LIGHTNING BOLTS TRACK & FIELD, AND EACH OF THEIR RESPECTIVE AGENTS, EMPLOYEES, REPRESENTATIVES, CONTRACTORS, PREDECESSORS, SUCCESSORS, ASSIGNS, OFFICERS AND AFFILIATES (COLLECTIVELY, THE "RELEASES"), WITH RESPECT TO ANY AND ALL CLAIMS, CAUSES OF ACTION INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY RELATED TO THE PRESENCE OR PARTICIPATION OF THE MINOR IN MY CHARGE, WHETHER ARISING FROM THE NEGLIGENCE (INCLUDING GROSS NEGLIGENCE) OF THE RELEASES OR OTHERWISE. TO THE FULLEST EXTENT PERMITTED BY LAW.

I represent and warrant that I have full right and authority to enter into this agreement on behalf of the Releasers, (including, without limitation, the above named minor), and no other person is required to enter into this agreement for and on behalf of the Releasers.

Signature of Parent / Guardian:*

Date:*

Emergency Contact Name:*

Phone:*

School:

Grade:

Parent's Signature*

Splitter

PARENTS and STUDENT ATHLETE CODE OF CONDUCT Deland Lightning Bolts Track & Field (DLBTF) is a subordinate of the amateur Athletic Union (AAU). The club, athletes, coaches, parents, spectators, and vendors are always subject to the AAU rules of conduct while engaging in any designated Team Event. Team Events include meets, practices, volunteer events, training sessions, meals, games, and meetings. DLBTF does not own property. DLBTF rents time and space through Facility Use Agreements with public and private entities including public county school boards, city and county recreation departments. DLBTF is considered a tenant during these Team Events. The club, athletes, coaches, parents, spectators, and vendors are subject to the rules of conduct for the facility while engaging in Team Events. Everyone associated with the club; including student athletes, coaches, parents, spectators, and vendors must also abide by the following Code of Conduct. Ant violation of these rules or anf DLBTF rule will result in immediate expulsion, forfeiture of membership for the current season, be subject for review for any other subsequent year, and may warrant a referral to AAU and law enforcement.

PROFANITY AND DISCRIMINATION OF ANY TYPE IS NOT ALLOWED AT ANY TEAM EVENT.
I/ We agree to not smoke at team events except in designated areas.
I/We agree to abstain from the possessing or drinking alcoholics beverages (unless otherwise excepted) and the possession or use of any illegal substance at any Team Event.
I/We agree to accept all decisions of the meet officials and judges as being and called to the best of their ability. Any issues arsing should be referred to a coach immediately.
I/We agree not to deliberately incite "unsportsmanlike" conduct or use "unsportsmanlike" cheers or chants in any fashion at any DLBTF, AAU, or USATF function.
I/We agree not to criticize, belittle, antagonize, berate or otherwise incite the opposing teams, athletes, coaches, fans, officials/judges and Commissioners by word or by gesture.
I/We agree to treat all person, Adult & Children, with respect while at any DLBTF function.
Any suspicions or allegations of Child Physical or Sexual Abuse MUST BE immediately reported to law enforcement and the AAU.
I/We will refrain from discussing team business outside of track meeting. (No Exceptions)
I/We agree to follow the proper chain of command when filing a complaint or voicing opinion regarding any possible rule infraction or concern within the DLBTF organization. (You may only advance to the next level in the chain of command providing your situation has not been handled within 72 hours from your initial filing and you need further assistance)

The Chain Of Command will be as follows:

The Team Manager/Team Mom will be first point of contact. If complaints is regarding any coach, you may go directly to the Head Coach or President.
A letter written to Deland Lightning Bolts Track & Field.

ACKNOWLEDGEMENT

Student Athletes are being trained and evaluated at all times for participation in various meets, events, relay teams, and competitive opportunities.
Your Best effort is expected & required at all times from athletes, coach, and parents.
Injuries to athletes MUST be reported immediately to the coaching staff.
I/We agree not to bring in noise making devices into any stadium as part of a Team Event.
I/We agree that guests and relatives are also subject to this Code of Conduct and will be held responsible for any violations occurring at an Team Event.
I/We agree to not interfere with the coaching staff's ability to coach my child.
Training techniques and goals can and will be explained if requested.

I have received, have read, understood and agree to the Parent and Student Athlete Code of Conduct by witness of my signature on the Signature Page.

Student Athlete Signature*

Date*

Parent's Signature*

Date*

Team Representative Signature: Coach Deke

Date*

REGISTRATION FORM

Email: [email protected]