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Player Registration

PLAYER First & Last Name

Date of Birth

Month

Day

Year

Athlete Shirt Size

Nick Name or Name & Player Number for back of Jersey

1. Parent(s) / Guardian(s) First and Last name

Phone

2nd Contact Parent(s) / Guardian(s) First and Last name

Phone

Player FULL Mailing Address

City

Zip Code

Parents/guardians are required to provide any diagnosed medical conditions that may affect their child’s safety or emergency care during practices or games. This information is collected solely to ensure safe participation to inform volunteers.

In order to help the volunteers and staff please inform of the players medical diagnosis. Some people may not know already what that is and we can educate them through orientation. :)

IF ANY HEALTH IMPEDEMENT ON PLAY RELAY COULD OCCUR; EXPLAIN IMPORTANT INFORMATION ON DISABILITY. Ex: Seizures, Overheating quickly, One-on-One assistance during play.

PLEASE note important instructions here to assist volunteers in the event they need to monitor that during game play.

Ex: Player gets over heated and could cause siezures.)

Uniform, Athlete Registration & Parent Gear

Athlete Player Fee$40

Parent ALOTO HAT (all one size) $15

Pay It Forward - sponsor a player that needs Financial Assistance to play$40

FAA Approved Prior to registration$0

Family/Parent shirt Order - Select Number to buy here. Fill in below information$25

Financial Assistance must be approved in advance by an authorized ALOTO staff member. Please select this option only if you have already spoken directly with Stephenie Coonrod before completing registration. If financial assistance is selected without prior approval, a payment notice will be sent, and the registration will be placed on hold and moved to the waiting list. Player spots cannot be held without confirmed approval.

PARENT/FAMILY T-SHIRT ORDER - Type SIZE, NAME for the back & Number - EX: Smith #7 SIZE Large

IF YOU ORDER A FAN SHIRT FOR YOURSELF PLEASE FILL IN THE ABOVE needed info for us to complete your purchase correctly.

SECOND PARENT/ FAMILY SHIRT ORDER IF NEEDED - SIZE, NAME FOR THE BACK, & NUMBER

THIRD PARENT/FAMILY SHIRT ORDER IF NEEDED - SIZE, NAME FOR THE BACK, & NUMBER

FOURTH PARENT/FAMILY SHIRT ORDER IF NEEDED - SIZE, NAME FOR THE BACK, & NUMBER

PERMISSION TO PARTICIPATE - INITIAL HERE

I accept full responsibility for PARTICIPANT to engage in the elected Program(s) as offered by the Parks and Recreation Division. I understand the nature of the Program, its activities, the dates and hours the Program operates, and fees. The Participant must have an adult carer on site at all times during game play.

FIT TO PARTICIPATE - INITIAL HERE:

FIT TO PARTICIPATE: I certify that PARTICIPANT is in good health and of sound body that warrants full participation in the Program and as outlined by the City of Temple Terrace Leisure Services Department Parks and Recreation Division.

Photo & Media Waiver - INITIAL HERE

I agree that the Parks and Rec., Division and A League of Their Own, Tampa may take photographs\video of Persons during activities, and that the Parks and Rec., Division, League may release Person’s name along with their picture for publication in newspapers, program brochures, fliers, social media, or use video tapes of Persons for public relations presentations.

Liability release waiver - INITIAL HERE

I acknowledge that the elected Program or activity may involve physical exertion and contact which may result in injury. I assume all risks incidental to participation including any risk or hazard from the activities and/or game play. I hereby waive, release, absolve, and hold harmless City of Temple Terrace, League of their own, Inc., its staff and elected officials, activity organizers, sponsors, participants and volunteers, for any loss, damage or injury to player during game activity.

Signature of Guardian/Parent

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