St. Junipero Serra Catholic SchoolA Ministry of Holy Trinity, St. Kilian, San Francisco Solano, and Santiago de Compostela Catholic Churches

After-School Sports Registration Packet

Enclosed in this registration packet you will find the following:

Emergency Form: This form is necessary in case of emergency and is carried with the coach and goes to every game. This form must be completed, signed and returned to the P.E. Office

Permission Form & Policy Acknowledgement Signature Page: This is a form required by the Diocese for students to play sports and to travel from the school. The page acknowledges that you have read and agree to the terms of the Permission Form, Eligibility Requirements, Uniform Responsibility, Participation Fee and Code of Conduct and must be completed, signed and returned to the P.E. Office.

Eligibility Requirements: As representatives of our school and community, athletes and parent(s)/guardian(s) of athletes shall be aware of the goals and objectives of St. Serra Catholic’s Sports Program.

Uniform Responsibility Agreement: All teams will be loaned high-quality uniforms which must be returned promptly at the end of each season or parents will be billed a fee to replace the uniform.

Participation Fee: If your child is selected to participate in a sport, there is a non-refundable participation fee.

Supplemental Authorization for Publicity: Under the current Authorization for Publicity Agreement that is signed each year during the registration process, we will not identify a student by name in any photos submitted for publication in local media. As we work to increase the number of press releases we submit, it is very important for us to provide the photos and accompanying captions to the publications immediately following an event. This form needs to be filled out each season for each athlete.

Driver’s Release Form: This form is required for parents who will be driving students other than their own, between events and St. Junipero Serra and will be kept on file.

Driver’s Insurance Verification: This form is required for parents who will be driving students other than their own, between events and St. Junipero Serra and will be kept on file.

**All participation paperwork and payment must be received in order for your child to receive a uniform and/or participate in any After School Sports Competitions.

Detach the following forms and return to the School Office or P.E. Office.

1.) ____ Emergency Form 2.) ____ Permission Form & Policy Acknowledgement Signature Page 3.) ____ Supplemental Authorization for Publicity 4.) ____ Driver Release Form (if applicable)5.) ____ Driver's Insurance Verification (if applicable)

Code of Conduct: All teams will be loaned high-quality uniforms which must be returned promptly at the end of each season or parents will be billed a fee to replace the uniform.

EMERGENCY FORM

_______________________________________________________________________________________________ Last Name First Name Homeroom DOB: Month/Day/Year Shirt Size (Youth or Adult)

LAST NAME HOME TELEPHONE GRADE

ADDRESS (HOME) CITY ZIP

FATHER FIRST NAME EMPLOYER WORK HOURS

ADDRESS (WORK) FATHER'S CELL PHONE FATHER'S E-MAIL ADDRESS

MOTHER FIRST NAME EMPLOYER WORK HOURS

ADDRESS (WORK) MOTHER'S CELL PHONE MOTHER'S E-MAIL ADDRESS

EMERGENCY CARE INFORMATION NAME RELATIONSHIP TELEPHONE

ADDRESS CITY ZIP

NAME RELATIONSHIP TELEPHONE

ADDRESS CITY ZIP

DOCTOR NAME TELEPHONE

ADDRESS CITY ZIP

The above named pupil has permission to participate in the interscholastic athletic program of St. Junipero Serra Catholic School for the academic calendar year 20__ to 20__.

I (we) understand that the school does not assume responsibility for payment of a physician. However, in an emergency you may choose a physician and/or approve of emergency care.

I (we) realize that there is a risk of being injured that is inherent in all sports. I (we) realize the risk of injury may be severe, including the risk of fractures, brain injuries, paralysis or even death.

I (we) the undersigned parent(s) or guardian(s) of (player’s name)________________________________, a minor, do hereby authorize and consent to any X-ray examination, anesthetic, medical or a surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency staff licensed under the provisions of the Medicine Practice Act or a Dentist licensed under the provisions of the Dental Practice Act and on the staff on any acute general hospital holding a current license to operate a hospital from the state of California Department of Public Health. It is understood that this authorization is given to provide authority and power to render care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above given treatment will not be withheld if the undersigned cannot be reached.

This authorization is given pursuant to the provisions of section 6910 of the Family Code of California.

__________________________________________________ ________________________ Parent Signature Date

ELIGIBILITY REQUIREMENT FORM

Philosophy of Athletics The St. Junipero Serra Catholic School approach to athletics stems directly from the school’s philosophy of education, since it is foundational to everything done in the school system. We believe our athletic program should aid in the spiritual, social, and proper physical development of the student athlete.

Goals: To share our faith with whom we come in contact, to require our athletes to strive to live like Christ, to have our athletes possess positive character qualities and to express them openly through the medium of athletics, and to provide young athletes with a chance to enjoy, develop and compete in athletics.

Athlete Eligibility Requirement As educators, we have a responsibility to see that academics are the number one priority for students participating in athletics. Students participating in St. Junipero Serra Catholic’s Sports Program will assume the responsibility of getting and completing all academic assignments when dismissed early for a scheduled game. The following policies are established to assure that the athletic program supports the physical and academic emphasis as stated in the PAL Handbook.

2. The administration reserves the right to remove an athlete from a team either temporarily orpermanently if, in the opinion of the administration, the athlete demonstrates poor behavior or citizenshipduring the school day or at athletic events or if the athlete does not meet the academic and conductrequirements as stated.

3. A student will not be dismissed from an after-school detention in order to make a prescheduled contestor practice.

4. For a student athlete to be eligible to participate in that day’s athletics contest, they must have attendedclass for ½ a day.

5. Students who earn 2 or more detentions in Academic Processing / Responsible Behavior at mid-season or at the end of any trimester will be placed on After School Sports Probation for a period of six weeks or based upon the severity may be asked to withdraw their participation for the selected season.

1. Student Athletes who have an overall academic average of the 5 core subjects (Math, ELA, Science, Social Studies and Religion) below a 70% at the mid-trimester or at the end of any trimester will be placed on After School Sports Probation for a period of six weeks or based upon the severity may be asked to withdraw their participation for the selected season. Terms of the After School Sports Probation will be determined by the administration. A conference to discuss these terms will be held with the administration, teachers, parents and student. (Students with an ILP must maintain the academic work agreement that is made with the teacher.)

UNIFORM RESPONSIBILITY AGREEMENT

St. Junipero Serra’s Sports Department has purchased high-quality uniforms to represent our school. St. Serra athletes are responsible for taking quality care of these uniforms.

If the uniform is not returned or is not in a condition that is satisfactory to the Sports Department, you will be billed the Uniform Responsibility Fee. The fee is determined by the cost of the uniform.

We agree to be responsible for the school uniform that is assigned to the student named above:

AFTER SCHOOL SPORTS PARTICIPATION FEE

Dear Parents,

If your child is selected and chooses to participate in a sport for St. Junipero Serra’s After-School Sports Program, there is a $110, non-refundable participation fee. The fee for Track & Field is $85.Please pay your participation fee online by going to our website at www.serraschool.org/campus-life/after-school-sports-program/fees.

Please note that all participation paperwork and payment must be received in order for your child to receive a uniform and continue participation in any After-School Sports.

Thank you for your participation and commitment to St. Junipero Serra’s After-School Sports Program.

Brock Gozbak Athletic Director

Codes of Conduct

CODE OF CONDUCT FOR PLAYERS 1. I understand the Code of Conduct as a player and I will abide by my coaches rules and the regulations of the

game.2. I will work as hard for my team as for myself. I will have fun, improve my skills, and won’t show-off.3. I will cooperate with and respect my coaches, teammates, opponents, and referees. I will treat them like I would

like to be treated.4. I will emphasize good sportsmanship. I know that unsportsmanship-like conduct towards the coaches,

teammates, opposing team, and game referees will not be tolerated.5. I will achieve an overall 2.0 GPA for the preceding trimester to be eligible for any sport, and I will always exhibit

appropriate behavior BOTH in and out of class.6. As an “A” team player, I must participate in any post-season play, which may extend for up to two weeks after

regular season play.7. I understand that participating on a St. Junipero Serra Catholic sport team is a season long commitment to my school,

my team, and my coach. If I quit or am dismissed from the team for any reason, I will be ineligible for any extra-curricular activities for the remainder of the school year.

8. Practices and games attendance policy are as follows.• EXCUSED ABSENCES INCUDE: Academics, illness, missing school, and family emergencies. In the case

of excused absences, if possible, please have your child contact the coach.

• UNEXCUSED ABSENCES: Any time a player does not show up for practice or does not tell the coach whythey are not going to be at practice is considered an unexcused absence. One unexcused absence for agame or practice will get a one game suspension (player will be at the game). Two more unexcusedabsences may result in the player being dismissed from the team.

• Unless an exception is approved administratively, students must attend a minimum of three classes in aschool day in order to participate in an athletic or extracurricular activity that day. Students who have anexcused absence from school are excused from practice, competition, or performance. They may notdress or participate on the same day as their absence unless an administrative exception is made.

Failure to adhere to the above Code of Conduct will result in a suspension from the games and/or practices.

CODE OF CONDUCT FOR PARENTS 1. I will teach my student to play by the rules.2. I will help my student work towards skill improvement and sportsmanship.3. I will not coach from the sidelines or the stands.4. I will set a good example by only speaking positively about my student’s team, teammates, and coaches.5. I will never argue or complain about the referees’ decisions.6. I understand I am not invited to team tryouts. (Coach’s discretion)7. I acknowledge that all coaching decisions are final. Any issues I have with a coach must be addressed directly

with the coach. If an issue cannot be resolved with the coach, then I will notify the Athletic Director.8. I recognize that, due to the various skill levels on each team, players will NOT receive equal playing time.9. 24-HOUR RULE: when it comes to communication over player concerns. Our coaches are here to coach

and develop our athletes. We ask our coaches, as volunteers, to coach with the best of their ability;however, there are instances where as spectators, you might not see things the same way they do.Please know that our coaches respect and value your opinions, but we ask that you wait 24 hours afterthe game before sharing your concerns with them. Conversations will be largely more effective andimpactful if all parties have time to think prior to speaking rather than in the heat of the moment. Ifthere is something that you feel needs to be addressed, the coach will gladly set up a time for it to bediscussed.

10. I have received, read, and agree to abide by the Code of Conduct for Parents.

Failure to adhere to the above Code of Conduct will result in suspension from viewing the games and/or practices.

PERMISSION FORM & POLICY ACKNOWLEDGEMENT SIGNATURE PAGE

______________________________________ has permission to participate in the interscholastic program of (First and Last Name of Child)

St. Junipero Serra Catholic School for the Academic School Year of 20__-20__.

Parents/Guardian, please initial on the lines that you’ve read and understand each of the following statements:

1.______I (we) realize that there is a risk of being injured that is inherit in all sports. I (we) realize the risk of injury may be severe, including the risk of fractures, brain injuries, paralysis or even death.

2.______I (we) the parent(s) or guardian(s) of the above mentioned player, do hereby authorize and consent to any X-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency staff licensed under the provisions of the Medicine Practice Act or a Dentist licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital holding a current license to operate a hospital from the State of California Department of Public Health.

3.______It is understood that the authorization mentioned in #2 is given in advance of any specific diagnosis treatment or hospital care being required , but is given to provide authority and power to render care which the aforementioned physician in the exercise of his/her best judgment may deem advisable.

4.______It is understood that effort shall be made to contact the parent or guardian prior to rendering

5.______Authorization #1- #4 is given pursuant to the provisions of section 6910 of the Family Code of California.

6.______I (we) understand that transportation will be by private vehicle.

7.______I (we) agree that in the event my child is injured as a result of his/her participation in St. Serra Catholic After-School Sports, including transportation to and from events, whether or not caused by negligence (active or passive) of the parish/school or diocesan youth activities program, or any of its agents or employees, recourse for the payment of any resulting hospital, medical, dental treatment or related costs and expenses will first be had against any accident, hospital, medical or dental insurance, or any available benefit plan of mine and/or of my spouse.

8.______I (we) are not aware of any medical condition of my child which would render it inappropriate for him/her to participate in any such activity.

9.______I (we) hereby give permission to the physician or dentist selected by the youth activities supervision personnel then present to render medical or dental treatment deemed necessary and appropriate by the physician or dentist.

10.______I (we) understand that participating on a St. Junipero Serra Catholic sport team is a season long commitment to my school, my team, and my coach. If I quit or I am dismissed from the team for any reason, I will be ineligible for any extra-curricular activities for the remainder of the school year.

By signing below, we agree to the above terms outlined on the Permission Form, Eligibility Requirements,

Uniform Responsibility Agreement, After-School Sports Participation Fee, and the Code of Conduct

Player's Name Printed ____________________________________

Player’s Signature ________________________________________ Date____________

Parent’s Signature ________________________________________ Date____________

__________________________________________________________________________________________________________

During the registration process, your family completed the Release Form for Publication, Video, Internet Consent, Technology Presentations and Release Agreement. Under these guidelines, the publication of pictures and information states that we will not publish any photos which individually identifies students without prior notification.

Due to the immediacy of submitting press releases and accompanying photos to local publications, it is often difficult for the school to obtain the permission required for identifying students in photos.

As part of the registration process for the activity for which you are now registering your child, we are including this supplemental authorization for publicity.

If you have any questions, please contact Cindy Kennedy, Communications Director at ckennedy@serraschool.

_______________________________________________________________________________________________

Authorization for Publication

Activity or Program ________________________________________________________________________(i.e. Boys Basketball, Academic Decathlon, Campus Ministry)

____ YES, my student (name) ___________________________________________________________________ may be included in any press releases associated with the activity named above. I understand that my student may be identified by name in any photos submitted for publication.

____ NO, my student (name) _____________________________________________________________________ may not be included in any press releases associated with the activity named above.

_____________________________________________________________ _______________________Parent Signature Date

Sport your child is playing: _________________________________________________________________ Season: ____ Fall ____ Winter____ Spring

Gender:_____ Male_____Female Team:____Canyon____ Mountain____ Valley

Student Name: _____________________________________________________________________________________ Homeroom (ie. 6B) __________________

I wish to participate in the activity described above, and as a condition of my being allowed to do so, I, hereby, release and discharge the Diocese of Orange, its constituent organizations, including but not limited to The Roman Catholic Bishop of Orange, a Corporation Sole, St. Junipero Serra Catholic School and their officers, agents, employees and volunteers from any and all claims for personal injuries or property damage that I may suffer as a result of my participation in the activity

described above, whether or not such injuries or damage are caused by the negligence (active or passive), of any of the enti-ties or individuals named or described above.

I, hereby, warrant and represent that I am physically fit and capable of taking part in such activity. I make this warranty andrepresentation on the basis of advice given me by a duly licensed medical doctor within the last six months, and I know ofno change in my medical condition since receiving such advice that would affect the opinion of said medical doctor.

I agree to abide by the rules and regulations governing the above described activity and to obey an instructions given by theperson or persons having supervision and control over the activity.

I, hereby, authorize the making of photographs, motion pictures, video tapes, recordings, or other memorializing of saidevent and my participation therein, and the publication or other use thereof. I, hereby, waive any right to compensationtherefore or any right that I otherwise might have to limit or control such making or use.

I warrant and represent that I am 25 years of age, or over, and upon request will produce satisfactory proof of such fact. Ialso acknowledge that I have been fingerprinted for the Diocese of Orange and have completed Safe Environment Training.

Signed this ____________________________________________________________ day of________________________________________ , ________________________.

Print Name __________________________________________________________________________________________________________________________________________

Signed by ____________________________________________________________________________________________________________________________________________

Street Address ______________________________________________________________________________________________________________________________________

City _____________________________________________________________________ CA ZIP ________________________________________________________________

Phone (__________)______________________________________________________ Facsimile (__________) __________________________________________________

e-mail __________________________________________________________________

Employee Statement: My participation in this activity will be conducted on my own time and not on my time as an employee of St. Junipero Serra Catholic School. Further, this participation on my part is for my own personal benefit, isvoluntary on my part, and is not as a result of any suggestion or direction of my said employer or anyone acting on itsbehalf. I am fully aware that any injury I may incur as a result of such participation will not be considered as a work-incurredinjury, or one arising out of or in the course and scope of my employment.

Diocese of Orange Adult Waiver and Release Form for Sports Carpool Drivers

Please complete and return to the School Office

K/CS/Forms/Driver Permission.qxp09/09/16

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St. Junipero Serra Catholic School23652 Antonio ParkwayRancho Santa Margarita, CA 92688Phone: (949) 888-1990FAX: (949) 888-1994

Carpool drivers must be approved volunteers and up to date on all

requirements.

Please attach a current copy of BOTH your driver’s license and insurance card.

Diocese of Orange Driver’s Insurance Verification

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St. Junipero Serra Catholic School23652 Antonio ParkwayRancho Santa Margarita, CA 92688Phone: (949) 888-1990FAX: (949) 888-1994

I carry my own Automobile Liability insurance with limits of $________________________________________________

and Medical Payments coverage with limits of $________________________________________________

Make, model, year of vehicle to be used________________________________________________________________________________________________________

# of seatbelts_______________________________________________________________________________________________

My driver’s license number _______________________________________________________________________________________________________________________

My insurance carrier is ____________________________________________________________________________________________________________________________

Policy Number ______________________________________________________________________________________________________________________________________

Policy Expires _______________________________________________________________________________________________________________________________________

My agent is __________________________________________________________________________________________________________________________________________

Address _________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________

Phone Number (__________) ____________________________________________________________________________________________________________________

Note: Please attach a photocopy of your current Driver’s License and Auto Insurance I.D. Card

Signed ________________________________________________________________________________________________________________________________________________

Address ______________________________________________________________________________________________________________________________________________

Home Phone (__________) _____________________________________________ Work Phone (__________) ________________________________________________

Date ____________________________________________________________________

Note: This form is for use by all Employees and Volunteers who drive their personal autos on Diocesan, School, parish orAgency business and activities.

Please attach a copy of BOTH your driver’s license and insurance card.