WELCOME to FALL REGISTRATION for 2017-2018!

WELCOME TO FALL REGISTRATION for 2017-2018!

FCC Member # ______

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PLAYER INFORMATION: ______

Please list your preferred team (if any)

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Last NameFirst Name Birthdate (DD/MM/YYYY)

Proof of Age used:______

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Street AddressCity Postal Code

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Best Contact NumberEmail Address (if applicable)

If Mobile, check preferred method: text___ or call___ (unless in case of an emergency)

PARENT AND/OR GUARDIAN INFORMATION:

Primary Contact:

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Last Name First Name Relationship to Player

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Street AddressCity Postal Code

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Best Contact Number (Required) Email Address (if applicable)

If Mobile, check preferred method: text___ or call___ (unless in case of an emergency)

Secondary Contact:

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Last Name First Name Relationship to Player

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Street AddressCity Postal Code

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Best Contact Number (Required) Email Address (if applicable)

If Mobile, check preferred method: text___ or call___ (unless in case of an emergency)

Player Medical History:

A copy of this information will be kept with either the Team Manager and/or Coach at all times during practices and games. The information provided will be a point of reference in the case of a medical emergency. It is confidential and will only be shared with coaching staff and/or medical personnel on a need to know basis. PLEASE PRINT CLEARLY.

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Last NameFirst Name Birthdate (DD/MM/YYYY)

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Care Card NumberFamily Doctor (or Favourite Clinic)Doctor’s Phone Number

Date of last Tetanus shot: ______

Existing Medical Conditions (please circle all that apply):

Other Medical Conditions not listed (please describe):______

Previous Injuries/Surgeries:______

Allergies, including food and environmental:______

Medications taken regularly:______

Are you prone to behavioural challenges when provoked, such as anger outbursts? YES NO

Corrective Lenses: YES NOIf yes, do you wear contact lenses? YES NO

Do you have vision problems not yet diagnosed? YES NO

Please list at least 2 reliable Emergency Contacts(use space at bottom if needed):

______First and Last Name Relationship to Player

______Preferred Phone Number Alternate Phone Number

______First and Last Name Relationship to Player

______Preferred Phone Number Alternate Phone Number

SPARTANS CODE OF CONDUCT:

Members and participants of Victoria Spartans programs and activities are expected to conduct themselves at all times in a manner consistent with the values of Spartans Football. This conduct applies to all forms of interaction including but not limited to face-to-face, electronic, or any form of social media. Conduct that violates these values may be subject to sanctions pursuant to the Victoria Spartans Football discipline policy. All participants and members of Victoria Spartans Football Association have the responsibility to:

Maintain and enhance the dignity and self-esteem of members and participants by:

Demonstrating respect to individuals regardless of gender, ethnic or racial origin, sexual orientation, age, marital status, religion, political belief, disability or economic status;

Focusing comments or criticism appropriately and avoiding public criticism of athletes, coaches, officials, organizers, volunteers, staff and members;

Consistently demonstrates the spirit of sportsmanship, sports leadership and ethical conduct and practices;

Ensuring that the rules of the sport and the spirit of such rules are adhered to.

Abstain from the use of alcohol and tobacco while participating at Spartans Football athletic events.

Abstain from the non-medical use of drugs or the use of performance enhancing drugs or methods.

Refrain from any behavior that constitutes harassment, where harassment is defined as comment or conduct, directed towards and individual or group, which is offensive, abusive, racist, sexist, degrading or malicious.

Refrain from any behaviour that constitutes sexual harassment, where sexual harassment is defined as unwelcome sexual advances or conduct of a sexual nature when submitting to or rejecting this conduct influences decisions which affect the individual, such conduct has the purpose or effect of diminishing performance, or such conduct creates an intimidating, hostile or offensive environment.

Comply at all times with the Constitution, Bylaws, policies, rules and regulations of Spartans Football, as adopted and amended from time to time, including complying with any contracts or agreements executed with Spartans Football.

Athletes who have been selected to be a representative of Spartans Football will have an additional responsibility to:

Report any medical problems in a timely fashion, where such problems may limit the athlete’s ability to train or compete;

Participate in all competitions, events or projects to which the athlete has made a commitment;

Adhere to Spartans Football requirements regarding clothing and equipment.

By signing below, I am declaring that I will agree to and abide by the Code of Conduct as presented above.

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Signature of PlayerDate

As the Parent/Guardian of the player above, I/we will encourage my player to abide by the Code of Conduct as presented above. I/We will also support Spartans Football in the enforcement of the code requirements as written.

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Signature of Parent/GuardianDate

Policy for the management of concussion and head injury in football:

In order to provide the players and their parents/guardians with assurance, please read below to understand what’s expected of coaches, trainers and other members of Football BC when it comes to concussion and head injury.

Football BC will not defend any association, director or coach who knowingly ignores our concussion policy.

As of June 1, 2010, all Football BC Member Associations, Clubs and Schools are required to provide the following information to all athletes and their parents or guardians:

All coaches are required to participate in a yearly education programprior to the season and must ensure the following requirements are fulfilled during the season:

1)An informed consent must be signed annually by parents and youth athletes acknowledging the risk of head injury prior to practice or competition;

2)An athlete who is suspected of sustaining a concussion or head injury must be removed from play – “when in doubt, sit them out”; and

3)An athlete who has been removed from play must receive written clearance from a licensed medical doctor prior to returning to play.

Football BC, in partnership with Parachute (formerly ThinkFirst Canada), has developed guidelines, pertinent information and forms to inform and educate coaches, youth athletes, and their parent(s)/guardian(s) of the nature and risk of concussion and head injury including the risks of continuing to play after concussion or head injury. Each member association and club will work in concert with Football BC and Parachute to disseminate these materials and ensure all members understand and comply with the new policy.

What is needed to be in compliance?

All Football BC Member Associations, Clubs, and Schools:

Shall adopt policies for the management of concussion and head injuries in youth football;

Shall ensure that all coaches (paid or volunteer) are educated in the nature and risk of concussions or head injuries prior to the first practice/competition (including education in the signs and symptoms of concussions/brain injuries);

Shall annually require all players and the parent(s) and/or guardian(s) of those players to sign and return an informed consent form relating to the nature and risk of concussion or head injury (this information sheet shall include the signs and symptoms of concussions/brain injuries); and

Shall ensure that any player showing signs or symptoms of a concussion or brain injury is removed from participation/competition immediately and not allowed to return to play until they have written clearance from a licensed medical doctor.

COACHES:

Shall be educated as to the nature and risk of concussions and head injuries, including the risks of continuing to play after concussion or head injury (including education in the signs and symptoms of concussions/brain injuries);

Must complete the “Making Head Way in Football” eLearning course available at

Shall educate their athletes on the signs and symptoms of concussions and encourage athletes to notify a coach or trainer immediately if they or a teammate exhibits those signs or symptoms;

What is needed to be in compliance continued ...

COACHES cont’d:

Shall immediately remove from participation/competition any athlete who is suspected of sustaining a concussion or head injury; and

Shall not allow an athlete who has been removed from play because of a suspected concussion/brain injury to return to play until the athlete has received written clearance from a licensed medical doctor.

PARENTS/GUARDIANS:

Shall annually review, sign and return to the Football BC via their child’s Association, Club or School an informed consent form on concussions and head injuries prior to the athlete's initiating practice or competition.

ATHLETES:

Shall annually review, sign and return to the Football BC via theirAssociation, Club or School an informed consent form on concussions and head injuries prior to initiating practice or competition;and

Shall notify immediately a coach if they or a teammate exhibit signs or symptoms of a concussion/brain injury.

Definitions:

Licensed Medical Doctor is a medical physician with an M.D. or equivalent degree or training that is licensed by the College of Physicians and Surgeons of B.C. For more information, contact (604) 733-7758 or visit

Online Resources:

The following documents can be found at

Concussion Information Sheet for Athletes

Concussion Information Sheet for Coaches

Concussion Information Sheet for Parents

Football BC Concussion Parent-Athlete Consent Form

Concussion Information Card (developed by ThinkFirst Canada)

Phone: 604.677.1025

Office Address: #222 – 6939 Hastings, Burnaby, BC

facebook.com/footballbc| twitter.com/football_bc

I have read the rules and guidelines for the concussion protocol. I will notify my Coach and/or Trainer if I experience a concussion and will follow all the advice as given by a medical doctor. I will NOT engage in further practices or games until such time as I am deemed concussion free by medical standards.

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Signature of PlayerDate

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Signature of Parent/GuardianDate

PARENT AND PLAYER CONSENT FORM:

While the Spartans Canadian Football Association of BC(a.k.a. SCFA and/or Spartans Football) and its directors, coaches and volunteers make every effort to make Canadian style tackle football as safe as possible you must recognize that it is a contact sport and that your child may incur an injury(s). We make every effort to ensure all gear is checked to ensure that players are protected. Injuries may arise from many causes including, but not limited to the following:

Player to player contact (including blocking and tackling)

Contact with the ground

Contact with the ball

Tripping and falling

Slipping and falling

Collision with practice equipment such as tackling sleds and dummies

Collision with field equipment such as goal posts, down boxes or measurement chain

Collision with game officials, coaches, managers or other on field volunteers

Accidents while traveling by public or chartered transportation providers

Accidents can be the result of nature of the activity and can occur with or without any fault on either the part of the player, the coaches or Spartans Football and its board of directors, or the facility where the activity is taking place. By allowing your son/daughter to participate in this activity, you are accepting the risk of an accident occurring, and agree that this activity, as described above, is suitable for your child.

I give (name of player) ______permission to participate in any event sponsored or approved by the Spartans Football Association. I understand that my child may be exposed to certain risks while participating in this activity. Accidents and injuries may occur.

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Signature of Parent/GuardianDate

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Printed name of Parent/Guardian

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Signature of PlayerDate

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Printed name of Player

PAYMENTS AND FEES:

The 2017 Fall Registration Fee Schedule is as follows:

Please note: we are now offering a payment plan, please ask if this is something you need to arrange

The amounts shown include the player insurance. If you register online, the insurance will show up as a separate line item and the registration amount will reflect the difference.

Family Discount: Every additional player from the same family/household is eligible for a $50 discount.

** These amounts are NOT covered by financial assistance organizations. Players/Parents are responsible.

^ Volunteer Deposit is based on approximately 10 hours of additional support that are REQUIRED

in order to have your Volunteer Deposit returned at the end of the season it is MANDATORY to complete a minimum of 10 hours and sell a minimum of 1 book of Raffle Tickets

you will be required to participate in at least 1 bottle drive or other fund raising event and participate in game day duties as assigned. When assigned for game days and you are unable to attend, you must get approval from the team manager to have a stand-in on your behalf (someone who is willing and capable)

Please make all cheques payable to: Spartans Football Association. A $35 fee is charged for all NSF cheques.

Due to the accounting practices required by the Gaming Commission, please write separate cheques for each fee. DO NOT COMBINE AMOUNTS INTO ONE CHEQUE. Also, make sure to print your player’s name on the memo line of your payment.If cheques are not an option for you, please set up a PreAuthorized Debit with your financial institution.

FINANCIAL ASSISTANCE:

If you are applying for financial assistance through an organization such as KidSport, Jumpstart or Athletics for Kids, please include proof of application being submitted prior to your player receiving their game jersey. Many of these organizations have a limit on how much you may be entitled to, which makes you responsible for the difference between any financial assistance funded and the required registration fees.

MEDIA RELEASE:

Please be aware the games will be video recorded for the primary purpose of game review as an additional coaching tool.It will be assumed you grant permission for the photo release unless you specify otherwise.

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