Parent/Guardian -

PO BOX 2089
Lake Havasu City, AZ 86405
(928) 680-0006
New Player
Returning Player
_______________________________ _________________ ______
Last Name
First Name
Primary Email (Required)
Parent/Guardian #1
Cell #
Secondary Email
Parent/Guardian #2
Cell #
Secondary Email
Emergency Contact
Phone #
Phone #
Hospital Preference
Medical Comments (Allergies or Special Conditions)
Division: 18u ____ 14u____ 12u ____ 10u____CP ____ TB ____
Divison Played Last year? ___________________ Position played last year: __________/__________
School player attends: ______________________ Is player trying out for T-bolt or LHHS team? Y / N
Please select Jersey size for Player:
Shirt Size: (Child) XS_____ SM_____ MD_____ LG_____
Shirt Size: (Adult) SM_____ MD_____ LG_____
Registration Fees:
$70.00 – T-Ball & Coach Pitch
$85.00 – 10u, 12u, 14u, 16u, 18u
$10.00 discount available for multiple children in the same household after the 1st player’s registration is
paid in full.
All Players are responsible for: Helmet, Black pants, Glove and Cleats.
There will be an additional $30 NSF fee for any returned checks
I have read and understand HGAS Rules, Refund Policy, Consent for Medical Release, Photo/Media Release, and
Zero Tolerance Agreement printed on the reverse of this form. I understand that team assignments will be by draft
or random assignment.
Parent/Guardian: ___________________________
Print Name
Payment: Amount $ _______
Check #______
Birth Certificate Provided: ______
Credit Card
Collected from: ___________
Revised: 11/14
Please read and sign the reverse side of this form, acknowledging that you have read and understand the following:
HGAS Rules
I (We), the parent/guardian of the above named candidate for a position on a league team, hereby, give my permission for his/her participation in any and all league
activities and hereby waive, release, absolve, indemnify, and agree to hold harmless Havasu Girls ASA Softball Inc., its organizers, sponsors, supervisors,
participants and persons transporting my child to and from league activities for any claim arising out of an injury of the above, whether the result of negligence or
for any other cause except to the extent and the amount covered by accident or liability insurance.
I (We) will furnish, upon request a birth certificate or other certified proof of age to league officials. No child will be eligible to practice or play ball until the
application and assigned sign up fees are returned to the league committee. The money will be placed in the league treasury for expenses. Please turn in your sign
up fee with this release form. I (We) acknowledge and will follow the Code of Conduct as posted at the complex and as issued in the bylaws of the Havasu Girls
ASA Softball Inc.
Refund Policy
NO REFUNDS will be issued except for extreme cases to be judged on a case by case basis by the HGAS Board. (Extreme cases may include: player relocation
out of league boundary, major injury or catastrophe) All refunds will assess a $25.00 fee to cover administration costs.
To request a refund, please submit a letter stating the following:
Players name, age, date of birth and Division played
Name and email address of the parent/guardian who registered and paid the fee
Detailed reason why the refund is being requested
Mailing address in which the refund (if one is granted) should be mailed
Refunds will not be issued if a uniform is ordered for the player. Please understand that uniforms constitute a large portion of the league’s annual expenses. The
parent/guardian who has requested the refund will receive notification stating the Board’s decision. All decisions are final. It may take up to one month to receive
notification of the decision.
All requests for refunds must be mailed to the following address:
Attn: Refund Committee
PO Box 2089 Lake Havasu City, Az 86405
Consent for Medical Release
I hereby give my consent for all medical care prescribed by a duly licensed Doctor of Medicine for my daughter as her parent or legal guardian. This care may be
given under whatever conditions are necessary to preserve the life, limb or well being of my dependent. I also authorize the officer, leader or coach, agent(s) of the
youth association to transport as required the minor to and form association sponsored activities including, but not limited to athletic and social events.
Photo and Media Release
I hereby consent, grant and give my permission to Havasu Girls ASA Softball, Inc., hereafter known as HGAS, to perpetually or otherwise use, exploit, adapt,
modify, reproduce, distribute, publicly display and publicly perform, throughout the world in any and all forms whether now known or later developed, the image,
name, or likeness of the above listed minor in any and all commercial exploits, promotional materials and announcements, publications, media releases, or
advertisements, electronic or otherwise (“Works”) and waive all rights to the same. I agree that neither the above listed minor, nor I, will receive any compensation
whatsoever for the granting of this release, if such image, name, or likeness appears in any Works, or form and proceeds of any utilized Work. I understand that
such image, name, likeness or resulting Work is solely the property of HGAS in perpetuity.
Zero Tolerance Agreement
Mission Statement
Havasu Girls A.S.A. Softball, Inc. is a non-profit organization dedicated to making the sports experience for all girls 4 to 18 years of age fun and healthy, by
promoting the value and importance of teamwork, sportsmanship and fair play in a safe environment. Our program is directed under the supervision of the Amateur
Softball Association, as well as the Jr. Olympics Program in Lake Havasu City.
We believe in the value and importance of sports and physical activities in the emotional, physical, social and mental development of youth. We also believe that
participation in sports and activities develops important character traits and lifelong values. Let’s remember these will be our leaders of tomorrow! Unfortunately,
there are always a small percentage of adults with agendas of their own that make a big impact on these simple goals!
The Havasu Girls A.S.A. Softball, Inc. Board of Directors has elected to enforce a Zero Tolerance Policy with respect to the conduct of players, managers,
coaches, parents and fans.
1. If any player engages in a fight, that player will automatically be suspended for 2 games. If the player engages in a 2 nd fight, she will automatically
be suspended for the remainder of the season. There are NO appeals, NO extenuating circumstances and NO refunds.
If a manager or coach engages in a fight, he or she will automatically be suspended from managing or coaching for the remainder of the season.
Managers and coaches are expected to set a proper example. There will be no second chances, NO appeals and NO extenuating circumstances.
Abuse, Taunting and Lack of Sportsmanship
Sportsmanship is the goal here! Abusive behavior by players, coaches, managers, parents and fans will not be tolerated. Abusive behavior includes, but not limited
to; foul language, arguing unreasonably with umpires, arguing with, taunting or cursing at players, managers, coaches or fans. It also includes throwing bats,
helmets or any other equipment.
The umpires have been directed to confront and warn any person who engages in such behavior. If the behavior persists, the offending person will be ejected. There
will be NO appeals of the umpire’s action. The ejected person will be required to leave the park immediately. If that person refuses to leave, the police will be
called to have them removed for disturbing the peace.
Any ejection of a player, manager or coach by the umpire for abusive or unsportsmanlike conduct will result in an automatic one game suspension. A 2 nd ejection
will result in a suspension for the remainder of the season. Again there will be NO exceptions.
Fans and Parents
The manager is responsible to inform and maintain control of the parents and fans affiliated with his or her team. If the manager cannot or will not control abusive
behavior by his or her team’s parents or fans, a forfeit will be declared and the game will be terminated, awarding the offending team with a loss.
No Smoking Policy
Havasu Girls A.S.A. Softball, Inc. events will be conducted in a “Drug Free” environment. Therefore, no smoking will be allowed in the stands, dugout, near the
field or in the immediate vicinity of any children.