2021-2022 GCA Sports Complex Program Packet
Please provide the parent/guardian email address. If needing to fill out more than one registration packet because of multiple athletes in the family, please use https://bit.ly/gcasportspacket2021-2022
Sign in to Google to save your progress. Learn more
Email *
Student Participant Name *
Guardians' Name/s *
Student Participant Grade for the 2021/2022 school year *
Emergency Contact (non guardian) Please include name, address and phone number: *
SELECT ALL PROGRAMS YOUR CHILD IS INTERESTED IN FOR THE ENTIRE YEAR. My child will be taking part in the following after school programs supported by the GCA Sports Complex for the 2021/2022 seasons (Please select all that may apply): It is important that both athletes and parents understand the time commitment of these sports and the costs that are associated with them. *
Required
I/We agree to pay an activity fee of $125 per program/sport my child is participating in. (The drama fee is charged out as $60 per fall production and $60 for the spring production.) The fee for any afterschool programming must be paid via FACTS account at the start of each program. Checks are NOT accepted and all payments must go through the family FACTS accounts. *
1. My child's participation in Guardian Christian Academy Sports Complex after school program is voluntary, and involvement in activities and events may require traveling or physical exertion. *
2. GCA is not responsible for the loss or theft of personal belongings. *
3. Misconduct on the part of my/our child may result in sitting out of practices, additional practice time, dismissal from the program, transportation home from an activity at my/our expense, or another penalty deemed appropriate by the Athletic Director/Coach/Program director. A student dismissed for a disciplinary reason will not receive a refund of the activity fee. *
4. I/We acknowledge that proper safety equipment, including, but not limited to, proper head gear, knee, shoulder, shin, and elbow pads, may be required to be worn and used properly by my/our child in order to participate in GCA sports and programs. *
5. I/We understand that, and authorize, my/our child’s image may be photographed or filmed and may be used in Video/CD/DVD presentations, social media forums, and/or printed publications for promotional purposes. These may include publications and/or websites owned or maintained by GCA or its' affiliates but will not be used for the purposes of direct financial gain. *
6. I/we acknowledge that even with the best observance of rules and supervision, injuries are still a possibility. *
7. I/We hereby relinquish any and all liability for any cause of action for personal injury, property damage, or wrongful death occurring to my/our child arising out of his or her participation in Guardian Christian Academy sanctioned events and/or activities. The terms of this waiver, release, assumption of risk and indemnity agreement shall apply through August 31, 2021 and by this agreement any such claims, rights, and causes of action that my/our child may have are hereby relinquished and my/our child (or parent(s)/ guardian(s)) do/does so on behalf of my/our and my/our child’s heirs, executors, administrators and/or assigns. *
8. I/We understand, acknowledge and assume all risks inherent in activities and sporting events, and understand that said sports and activities involve risks to my/our child’s person including bodily injury, concussions, partial or total disability, permanent or partial paralysis, and death, and damages which may result, and that I/we have full knowledge of said risks, and that these risks and dangers may be caused by the negligence of my/our child or the negligence of others. It is further acknowledged that there may be risks and dangers not known to Guardian Christian Academy, to us, or are not reasonably foreseeable at this time. *
9. I/We acknowledge and understand and assume the risks, if any, arising from the conditions and use of the facilities used in Guardian Christian Academy sanctioned activities and related premises and acknowledge and understand that included within the scope of this waiver and release is any cause of action, arising from the performance, or failure to perform maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said facilities. *
10. I/WE ACKNOWLEDGE THAT I/WE HAVE READ THE ABOVE TERMS AND HAVE NOT RELIED UPON ANY REPRESENTATIONS OF RELEASES, THAT I/WE ARE FULLY AWARE OF AND HAVE BEEN ADVISED OF THE POTENTIAL DANGERS OF THE ACTIVITIES AND/OR SPORTING EVENTS DESCRIBED ABOVE, AND SIGN THIS AGREEMENT VOLUNTARILY, UNDERSTANDING THAT IT IS NECESSARY TO ALLOW THE AMATEUR EVENTS DESCRIBED ABOVE TO EXIST IN THEIR PRESENT FORM AND PRESENTATION. Please provide your typed name below as your online signature to acknowledge that you have read and agree to all information contained herein. *
I give permission for my student to ride to and from practices, games, and/or special events on the GCA van/bus. *
I give permission for my student to ride to and from practices, games and/or special events with another parent. *
Please provide those authorized to pick up and transport to and from school/athletic events during the 2021-2022 school year, ending August 31, 2022. Be sure to include person's name, their relationship to the athlete, address and phone number. *
I give permission for my student to drive himself/herself to practices and home games or program events. *
I understand the above provided permissions regarding: 1) the transportation to and from a sports event. *
Only those involved in a sporting activity need to have a physical on file. This includes competitive cheer . Cheer physical forms can be received by asking the cheer coach or the athletic director. Drama and fine arts are not required to have a physical. Please use the link provided to print the physical form, as needed, for your student athlete. Competitive cheer physical form used are available can be found here The physical form MUST be completed prior to their participation in GCA athletics. By agreeing to this, you understand that this form is mandatory in order to participate in GCA athletics and must be received before the student participates in any sporting events. https://www.vhsl.org/forms/ *
A GCA representative or staff member/ coach may authorize medical treatment if I am not available for my child? *
Please read and sign the concussion form your student will bring home after accepting a membership to the team. Forms may be turned into the athletic department office located in the gym or turned into the coach. All athletes must have a signed concussion form on file before practice starts.
All athletes must have a sports waiver on file. Those waivers may be found at https://bit.ly/gcasportswaiver . Please sign and bring in with physical and concussion form.
Please have your STUDENT read the following: As a participant in GCA Sports Complex Afterschool Programs, I agree to invest my time, talent, energy and efforts in my chosen GCA programs. I agree to be respectful to all coaches, players, referees, fans and attendees at special events. By providing my (STUDENT NAME) name below, I am in agreement with the above statement and all the rules/regulations set forth in the GCA Student Programs Handbook: *
As guardian/s to my student, I agree to read all of the material presented to our student in the GCA Student Programs Handbook and will be respectful to all coaches, players, referees, fans and attendees at all special events. By providing my name below (PARENT NAME), I am in agreement with the above statement and all the rules/regulations set forth in the GCA Student Programs Handbook: *
Do you agree to be background checked if you volunteer your time and talent to the GCA after school programs? *
CONTACT INFORMATION FOR AFTER SCHOOL PROGRAMS PACKET QUESTIONS OR CONCERNS: 804-566-9669 direct line to the gymnasium
Doug Dillon: Athletic Director ddillon@gcakids.com
Melody James: Assistant to Athletic Director mjames@gcakids.com
Kelly Hooks: Events Coordinator khooks@gcakids.com
I, as this student's parent/guardian, hereby consent for my student to participate in the program/s checked above and agree to allow his or her participation in all practices/contests/special events. I understand the practice/contest schedule/special events schedule. I have read, understand , and agree to the terms provided by my student program's director and/or coach. I have read the Student Programs Handbook/ Policies and agree to adhere to the guidelines therein. I understand that the notarized Health Consent and Waiver form pertains to the sports activities (only) as well. I understand that the after school programs fee is nonrefundable. My name typed below indicates my agreement to all of the above. *
Once all paperwork is filled out, please have the student bring the following forms directly to Doug Dillon's office- concussion, waiver, and physical . Please DO NOT submit or turn in those forms to a teacher or front desk staff member. The online form above can be submitted electronically by hitting submit when all questions are answered. Thanks for your time and we are looking forward to a productive sports season for the 2021-2022 school year!
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy