Aaron Foreman 240-464-7367
Impact Sports and Academic Services [email protected]
PO Box 1363 Lexington Park, MD 20653
Damon McGill 240-577-5435
MEDICAL FORM
Student Name: ______
Assumption of Risk and Consent for Treatment
I understand that there is an inherent risk of injury with my participation in full contact football, and that this injury may lead to permanent disability or death. In the event of routine of emergency health examinations diagnostic procedures, treatment of illness, and/or injuries, permission is herby granted to treat the athlete above by the IMPACT SPORTS medical staff, physicians associated with other community facilities as needed.
Signature of Parent: ______Date: ______
Signature of Student: ______Date: ______
Medical Insurance Information
Indicate the status of your personal health insurance coverage. If covered, the information indicated below must be provided for all applicable policies.
______I am not covered by a health/accident insurance policy.
______I am covered by my own health/accident insurance policy.
______I am covered by my parent’s health/accident insurance policy.
Health Insurance Company Name & Address: ______
______
Group #: ______Policy #: ______
Physician Consent
Height: ______Weight: ______Blood Pressure: ______
Allergies: ______
Medication student-athlete is taking: ______
Previous Medical Conditions: ______
______
Previous Orthopedic Conditions: ______
_____ Student-athlete cleared for all full contact physical activities (full contact football)
_____ Student-athlete restricted from physical activities, reason and/or conditions for clearance (if any)
Conditions for clearance (if any): ______
______
Signature of Doctor: ______Date: ______
(Doctor’s stamp of approval also required)
2011 FOOTBALL SCHEDULE
Times Are Subject To Change
Practice Begins/Camp July 30-1 TBD
TBD
Weight Training- TBD
Speed/Agility- TBD
SCHEDULE
TBD
CHESAPEAKE STORM SCHOOL PLAYERS/PARENTS:
Mission:
Impact Sports and Academic Services, mission is to ensure young men/women in the Tri County area an opportunity to achieve in athletic and academic endeavors. Impact Sports offers team sports, life skills, personal development, job/career assistance, job training, entrepreneurship, college placement, scholarships and mentoring to young men/women between the ages of 11-21. Minimum age for football is 13-18. We know that there are late birthdays but they have to turn 14 before the season starts and not turn 19 until after the season has started.
Chesapeake StormProgram is for home schooled students, private schooled students with no football program and public school students looking for another option to play football.
About Us:
In 2007 Impact fielded a 14 & Under AAU Football Team that ranked 3rd in the nation its inaugural season. Additionally, for the last 4 years we have hosted the NFL HSPD/JPD football programs at The Kings Christian Academy and Cheltenham Youth Detention Facility. These camps allow middle/high school students to learn various skills necessary to be an excellent student athlete. We realize the boundless life skills athletics can teach young men such as teamwork, character, discipline, self- esteem, pride, perseverance and responsibility. Those that supported the program last year and are returning should be pleased to know what these young men accomplished, and your support was greatly appreciated.
THIS TEAM HAS NO AFFILIATION WITH LEONARD HALL JR NAVALACADEMY!! Our fourth season promises to be a memorable one. To that end, we thank you for allowing your child(ren) to participate in this program.
Athletic Fee:
An athletic fee of $275with a minimum down payment of $75 is due by August 1st, 2011. This fee is required to cover the cost of these fees which include but are not limited to: insurance, equipment replacement, administrative, transportation, etc. A breakdown of what this fee covers is provided in our correspondence. ALL END OF YEAR TROPHIES AND CERTIFICATES WILL BE HELD UNTIL ALL FEES, EQUIPMENT AND UNIFORMS ARE RETURNED. NO PLAYER WILL BE ISSUED GEAR UNLESS THE ATHLETIC FEE BALANCE IS PAID IN FULL PRIOR TO THE FIRST DAY OF ORGANIZED PRACTICE. MONEY ORDERS or PAYPAL PAYMENTS ONLY!! After August 1st there is no athletic fee refund.
MAKE CHECKS PAYABLE TO: Aaron M. Foreman in the memo write C/O Impact Sports
PO Box 1363 Lexington Park, MD 20653.
After August 8, 2011 the athletic fee is 285.00 dollars will be assessedfor late registrations after the August 1, 2011 date.
We have several payment plans to make it affordable so that your child can participate. You can pay your minimum $75 for the registration down payment. The $75 minimum registration fee is still required for all team members no exceptions. We will work out a payment plan with you to meet your needs so that there will be no delay in your child taking the field.
PAYPAL WEBSITE: Go to is the payment email address. If interested in paying by credit card you can email us and we will send you an invoice that gives instructions for paying via check and credit card through this vehicle.
MEDICAL: Outside of our required athletic physical. Please note your son’s physical should be an athletic physical not a regular physical!! Along with the physical a copy of a current medical card is mandatory! We do not want to have to wait for treatment for your son in an emergency situation! Please make a copy of the front and back of the card and submit it with the application.
INJURIES:
If a player should become injured a Physician’s note is needed prior to their return to practice. No exceptions.
ABSENCES:
The purpose of team sports is also teaching responsibility and accountability. The coaching staff requires the player to contact a coach in regards to an absence. Not the parent. We do understand cases where the parent may need to call but we want the responsibility to be on the player. A phone roster will be provided prior to the season starting. Too many unexcused absences could result in a team meeting to dismiss your child(ren) from the team. If this occurs there will be no refund.
Weather: Football is an outdoor sport played in all types of weather conditions. This includes the rain. The safety of our players is paramount. We will practice unless there is lighting or other unsafe conditions. We will have other accommodations for indoor practices. Should practice be cancelled we will work on an alert system on our website and through email and text messages.
Coaches Conduct: If at any time there is an issue between a player and a coach a meeting will be conducted between the player, parent, coach and head coach. Parents should report all incidents to the head coach so that due process can take place.
Field Locations:
Practice Field: see site
Game Field: Fifth District Park
TBD
FAMILY: Faith, family and football. These are the core beliefs of our organization and staff. There will never be a situation where we will get in the way of family obligations, church obligations etc. There may be time when Coach Foreman or one of the staff may not be in practice to attend to their own family. We do understand. This is a core belief that will not be compromised.
Fundraisers:
In order to defray the rising cost for this sport and other fees that may arise we are asking that families participate in a minimum of two out of three fundraiser. We do not want to have to ask you for any more funds than we already are. Football is a very expensive sport and very costly. Therefore it is a minimum requirement that each parent, guardian or family member participate in at least 2 fund raising programs. If each family commits to doing 3 fund raisers, we will have enough funds to offset any out of pocket expenses.
If you have extenuating circumstances that preclude you from participating in our fundraisers speak with Coach Foreman or his wife Toni directly and other accommodations will be arranged. This will be on a case by case basis.
We are very open to any fundraising ideas you may have. We welcome the help!!
Pending Fundraisers:
Carnival Labor Day Weekend
Joe Corbi
Air show Labor Day Weekend
Park Rock Labor day Weekend
Sponsors:
We are currently looking for sponsors to assist with all aspects of the team. This ranges from new game uniforms, helmets, field equipment, lights and a field container for gear. Businesses are welcome! We will provide some type of free advertisement for their support. Please see Coach Foreman for a detailed list of needs.
Volunteers:
We do need help in all areas of the team. Remember this is OUR team!!
Areas of Need:
Team AdministratorsConcessions Manager
Bus MechanicBus Driver (Must have CDL)
Construction Company (Field Maintenance)Trainer/Team Doctor (Preferably CPR/First Aid Certified)
Directions/LogisticsFundraising Coordinator
Equipment ManagerCarpool Coordinator
Scheduler/Team Accommodations Academic Advisor
Halftime Snack Support Webmaster
StatisticianPublic Relations
Videographer/Photographer
Forms:
Each student is responsible for signing a player contract. Parents will also sign a parent contract. Additionally, players are required to present a bi-weekly academic progress report. Because academics is a priority we also hold a mandatory study hall for all players as academics are paramount. This is designed to assist student athletes to achieve their academic success. A location along with days and times will be determined.
Transportation:
We have a team bus that will be used mainly game purposes. We will use it sparingly as needed for normal practice days should the need arise. We do need assistance in carpooling. Please speak with us if you should have a solution. We also need a place to store our bus.
We are exploring pickup points in the county for practices. We will be updating you shortly.
Equipment:
A location is being secured to hold all players’ equipment.
An equipment issue sheet will be provided upon receipt of equipment. This is to be signed by the player and a parent/guardian.
Equipment will be issued after August 8th and before the 30th at Extra Space Storage in California, Md. Time TBD.
Please sign on for your commitment. As always we appreciate your participation and look forward to a winning season and working with your child (ren.) Go Chesapeake Storm!!!!
ATHLETIC FEE BREAKDOWN: $275.00
Administrative Fee:75.00
Field Fees:100.00
Equipment Fee75.00
Referee Fees25.00
Total: $275.00
AGREEMENT TO WAIVER OF CLAIMS AND LIABILITY RELEASE
In consideration of his acceptant as a Participant with Impact Sports/Football (hereafter the “Program”), the undersigned Participant (hereafter “Participant”) and Participant’s parent(s) or legal guardian(s) agree to the following Waiver of Claims and Liability Release (hereafter the “Waiver and Release”), which will cover events occurring from the time the Participant commences his participation in the Program until the termination of his participation therein.
WAIVER OF CLAIMS AND LIABILITY RELEASE
It is the intent of the undersigned Participant and his parents or legal guardians to release Impact Sports/representatives of Impact Sports and each of their respective affiliates, officers, directors, agents, sponsors), and employees (collectively the “Impact Sports Entities”) from any claims or liability to the fullest extent possible under the law, as such the undersigned hereby agrees as follows:
- WE UNDERSTAND AND HEREBY ACKNOWLEDGE THAT THE GAME OF FOOTBALL IS A FULL-BODY CONTACT SPORT THAT PRESENTS THE INHERENT RISK OF SERIOUS BODILY INJURY, AND OUR WAIVER AND RENUNCIATION OF CLAIMS IN THIS AGREEMENT EXPRESSLY APPLY TO ANY BODILY INJURY, DAMAGE, OR ACCIDENT THAT MAY BE SUFFERED BY PARTICIPANT OR OTHERS RESULTING FROM THE PARTICIPANT’S PARTICIPATION IN THE GAME OF FOOTBALL IN CONNECTION WITH THE PROGRAM.
- We the undersigned, as a Participant in and the parents or legal guardians of a Participant in the Program, hereby waive and renounce any claims against Impact Sports participating in the Program, including without limitation any claims based on negligence, for any injury to the Participant or others, loss damage, sickness, accident, delay, or expenses of any kind whatsoever resulting from the Participant’s participation in the Program.
- We also agree to hold harmless Impact Sports and all coaches, and any other entity affiliated with Impact Sports from any and all claims arising out of the equipment or uniform supplied to Participant for use in the Program, or the equipment or other materials used by Program staff in implementing the Program.
- We understand and acknowledge that Impact Sports do not guarantee the security or safety of Program sites, of the areas adjacent to and surrounding Program sites, or of any areas Participants may traverse on their way to or from Program sites. We release Impact Sports from any and all claims arising out of accidents or events caused by a Participant or third parties not associated with the Program, which incidents could occur on Program sites, in areas adjacent to or surrounding Program sites, or in areas traversed by Participants traveling to our Program sites. We further release Impact Sport from liability for any damage or injury that may occur as a result of the surface or condition of the Program site itself (e.g. the football playing field), or the condition of facilities or equipment used at the site.
- We recognize that the Participant must obey the instructions of coaches, their assistants, and any other Program staff, and we have instructed the Participant to obey said coaches and other Program staff. We understand and acknowledge that the Program staff and Impact Sports reserve the right to terminate the participation in the Program of any Participant whose conduct may be considered by IMPACT SPORTSin its sole discretion, to be detrimental to or incompatible with the interests and security of the Program orImpact Sports. In the event of any such action by IMPACT SPORTS, we understand and acknowledge that we will have no right to any compensation or damages from Impact Sports.
- We represent and confirm that the Participant has undergone, or will undergo prior to commencement of his participation in the Program, a full and comprehensive physical examination administered by a Board-certified physician who will supply to IMPACT SPORTS or its designated representative a letter certifying, on the basis of aforementioned physical examination, that the Participant is physically fit to play the game of full-contact football and otherwise to participate in the Program. We further confirm that we have executed, or will execute prior to commencement of the Participant’s participation in the Program, the “medical history” form provided to the Participant at the time of his registration for the Program, and we will return the executed medical history form to Impact Sports.
- We further understand that should any medical services be provided or made available to the Participant in connection with his participation in the Program, the provision or availability of which Impact Sports do not sponsor or guarantee, Impact Sports does not warrant or make any representation concerning the adequacy or continuation of such medical services, nor can Impact Sports be deemed responsible or held liable for any claims arising out of the provision of such medical services or the failure to provide or to continue to provide such medical services. We also understand that the Impact Sports cannot be held liable for any other services provided herein, including without limitation any coaching, counseling, transportation, or security services and any core course recommendation made by any member associated with the Program is simply a recommendation.
- We hereby grant Impact Sports and its designees the right to use the name, image, likeness, photograph, and biographical material pertaining to the Participant throughout the world in any and all media, now known or hereby created, in connection with promoting or publicizing the Program or any other endeavor.
- We hereby grant Impact Sports and the Program counselors and teachers access to Participant’s high school transcript for use only in connection with the Program. We acknowledge that such transcripts may be provided to certain college coaches or college athletics personnel who may request this information about the Participant but such information will not be released to other persons not affiliated with the Program.
- If any portion of this Waiver and Release is declared invalid or unenforceable by a final judgment of any court of competent jurisdiction, we hereby agree that such determination shall not affect the balance of this Waiver and Release, but this Waiver and Release shall remain in full force and effect, as such invalid portion shall be deemed severable.
Full name of Parent or Guardian (First and last name)
______
Signature of Parent or Guardian Relationship to Participant
Full name of Participant (First and last name)
______//
Signature of ParticipantDate
Address City/State Zip
//
Phone Number Age as of December 31Birth-date of current year
Email Address
Impact Sports Parent Contract (Parents, please read and sign this agreement.)
Mission
It is the mission of the Impact Sports to provide a positive, competitive high school football experience for player, parent and coach. We emphasize long-term player development of physical, emotional and social skills. While we are currently not in a league but independent we eventually will compete for playoffs so the kids can have that experience. Winning will not be placed above good sportsmanship (defined as respecting rules, opponents, officials, teammates, and one’s self) or what is best for the team or any individual athlete. It is our goal to create an environment that will benefit the individual as well as the team. We believe a positive team sport experience will promote a youth’s self-confidence and self-esteem beyond the football field.
Expectations
This Code of Conduct is a written contract between parents, players and coaches to abide by the rules and regulations of the game. We expect all parties to maintain a positive attitude and uphold the ideals of fair play and sporting behavior. This contract is more than just paper, it is the essence of our goals and objectives and thus, adherence to it is of primary importance. To participate in our club activities, all parents are required to agree to and sign this Code of Conduct.
Parent’s Pledge
The essential elements of character-building and ethics in sports are embodied in the concept of sportsmanship and six core principles: trustworthiness, respect, responsibility, fairness, caring, and good citizenship. The highest potential of sports is achieved when competition reflects these "six pillars of character." 1