P.O.BOX 802, SAN LORENZO, CA 94580-0802
Filcom Co-Ed Basketball Kids League registration is now open. The league will start at 10:00am on Saturdays, as gym availability permits, and will start in August 28, 2011. Divisions will include Fifth Grade Boys and Girls, Sixth Grade Boys and Girls, and Seventh Grade Boys and Girls. Divisions will be based on participation and may be combined at Filcom’s discretion. All "mixed grade teams" will play in the division of their oldest player unless we have enough to make a "mixed age" division. Rules and roster forms can be found on our website at www.filcomhoops.org. Games will be 10 minute running clock per quarter with the clock stopping in the last one minute in the first half and last two minutes of the second half. Cost is $80 per player.
Each division will be limited to 6 to 8 teams. Be aware that more invitations have been sent out than available spots. The committee will make all final selections of participating teams. Awards are limited to twelve players per team.
Please email us at filcominfo@gmail.com if you have any questions or want to register a team.
Photographs / Video Consent
My child has my permission to participate in the activities of Filcom Basketball Association, and I consent that Filcom Basketball Association may, in its discretion, place basketball game or practice photographs of my child on its website.
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Parent/Guardian(s) Printed Name Parent/Guardian(s) Signature Date
Emergency Consent for Treatment of Minors
As the undersigned parent/guardian of ___________________________, whose birth date is _________________, in the event the parent/guardian cannot be contacted through reasonable efforts, do hereby empower and grant to Filcom Basketball Association permission to consent to and authorize medical and
Hospital care and treatment for my above named child. I hereby release and hold harmless the physicians, hospital and other persons who act in reliance upon this authorization from all liability in performing any and all medical and surgical procedures which they, in their sole discretion, deem necessary.
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Parent/Guardian Signature Date
This Emergency Consent for the Treatment of Minors section must be completed by the parent/guardian so that your minor child can be treated whether you are present or out of contact at the time the emergency occurs. The above information must be signed and returned prior to any participation.
WAIVER FOR PLAYER & VOLUNTEERS, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
IN CONSIDERATION of being permitted to participate in any Filcom Basketball Association activity, I and/or my minor child, our personal representatives, assign heirs and next of kin:
1. ACKNOWLEDGE, agree, and represent that I and/or my minor understand the nature of Filcom Basketball Association and that I and/or my minor child are qualified, in good health, and in proper physical condition to participate in such activity. I further agree that if, at any time, I believe conditions or equipment to be unsafe, I and /or my minor child will immediately discontinue further participation in the activity.
2. FULLY UNDERSTAND that: (a) FILCOM BASKETBALL ASSOCIATION ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by me and/or my child's own actions, or inactions, the actions or inactions of others participating in the activity, the condition in which the activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I and/or my minor child incur as a result of my participation in the activity.
3. HEREBY ACCEPT AND ASSUME ALL SUCH RISKS, KNOWN AND UNKNOWN, AND ASSUME ALL RESPONSIBILITY FOR THE LOSSES, COSTS, AND/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS, OR DEATH, EVEN IF CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW;
4. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO FILCOM BASKETBALL ASSOCIATION, their respective member teams and leagues, their administrators, directors, agents, officers, volunteers, team members and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, I and/or my minor child, or anyone on my and/or my minor
Child’s behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
By my/our signature, I/we certify that I/we have read points 1 thru 4.
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Parent / Guardian(s) Printed Name Parent/Guardian(s) Signature Date
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Parent / Guardian(s) Printed Name Parent/Guardian(s) Signature Date
PARENTS ARE REQUIRED TO READ, SIGN AND DATE THIS AGREEMENT.
1. I understand that Filcom Basketball Association is organized to promote youth athletics and good sportsmanship.
2. I understand that my conduct as a parent will have a definite impact on the youth for whom it is intended, the program, and myself.
3. I pledge to support, cooperate, and work in every way to promote youth athletics in the best interest of the programs and youths involved.
4. I pledge to be respectful to all officials, even in an expression of disagreement.
5. I do agree to adhere to the principles of good sportsmanship and to the rules and regulations defined by Filcom Basketball Association & all other sport affiliations.
6. I understand that if I display poor sportsmanship, whether during or following a game, I will be subject to partial or permanent program suspension. Unsportsmanlike conduct is defined as, but not limited to the following:
a. harassment of participants or officials
b. use of profane language and / or gestures
c. public threats or physical violence
7. Regulations regarding adult's ejection or suspension will follow the guidelines listed below:
a. I understand that if I am asked to leave a game, I will be suspended from attending the next game to be played by my son's / daughter's team.
b. I understand that if I am asked to leave a second game during any one season, I will not be allowed to attend all the remaining regular season games and the end of season tournament activities.
c. I understand that if I am found under the influence of alcohol or drugs while at a Jimmy Smith Athletics function, I will not be allowed to attend any preseason activities, all regular season activities, and all end-of-season activities that my son's / daughter's team may be involved in. Alcoholic beverages are not allowed at Filcom Basketball Association’s facilities.
d. I understand that the Filcom Basketball Association Board will review all adult ejections or suspension and may extend any suspension beyond what is stated above as deemed appropriate for the offense.
8. I understand that any suspension may be appealed by using the following process: The suspended individual (parents, guardians of a player) should submit in writing a detailed account of the incident to the C.E.O. within 48 hours of the incident. The statement should give names of any witnesses that observed the incident. The C.E.O. then will perform a preliminary investigation and make a recommendation to the coaches.
I UNDERSTAND THAT FAILURE TO ABIDE BY ALL ITEMS ABOVE COULD RESULT IN SUSPENSION OR DISMISSAL FROM FILCOM BASKETBALL ASSOCIATION.
Parent or Guardian ________________________________ Date _____________
Parent or Guardian ________________________________ Date _____________