Baseball. Speed & Agility: This training regimen will help build the athlefic ability
... The P&G Cincinnati MLB Urban Youth Academy provides FREE year-round ...
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2015 FALL APPLICATION Participant Name: Phone:
Email Address:
Please select all of the following in which you are interested in participating: Baseball
Softball
Speed & Agility: This training regimen will help build the athletic ability of the participant. No weights involved. Oct. 5th thru Dec. 28th _____ Ages 8-18 Monday & Wednesday 5:30-6:30
Speed & Agility: This training regimen will help build the athletic ability of the participant. No weights involved. Oct. 5th thru Dec. 30th _____ Ages 8-18 Monday & Wednesday 5:30-6:30 Fundamental Clinic: Basic Softball training & Instruction Oct. 21st thru Dec. 16th _____ Ages 8-18 Wednesdays 6:30-8:30 Skill Development: Softball Fielding Instruction
_____
Skill Development: Specific position Instruction Oct. 8th thru Dec. 17th Ages 13-18 Thursdays 5:30-7
Position(s)___________________________
_____
Fundamentals Clinic: Basic Baseball training & instruction Oct. 27th thru Dec. 29th Ages 8-12 Tuesdays 6:30-8:30
Lifting & Conditioning: Lifting to help increase the strength and longevity of participants. Oct. 5th thru Dec. 30th _____ Ages 13-18 Mondays & Wednesdays 6:308:00 PM & Saturdays 8:30-10:30 AM
Oct. 5th thru Dec. 21st
_____
Ages 13-18 Mondays 6:30-8:30 Lifting & Conditioning: Lifting to help increase the strength and longevity of participant Oct. 6th thru Dec. 29th _____ Ages 13-18 Tuesdays & Thursdays 6:30-8:00
T-Ball Fundamentals Clinic: Instructional clinic designed to create an understanding of
_____
the game and to develop fundamentals. Oct 11th thru Dec. 13th Ages 5-7 Sundays 1:30-4:30
Individual Instruction Monday - Thursday starting September 7th: 4:00 - 9:00 All applicants must call in advance to schedule time with one of our coaches: 513-765-5000.
**All programming will include a half an hour of tutoring/educational work with UC Graduate Students** Enrollment is LIMITED. Applications will be taken on a “ First need ” basis. Applications can be returned to the address listed below or at
[email protected] Baseball and Softball Equipment can be provided.
2026 E. SEYMOUR AVENUE, CINCINNATI, OH 45237
For more information please visit reds.com/academy or contact Cameron Satterwhite at (513) 765-5000 or Fax to (513) 351-2067 Email:
[email protected]/Follow @RedsCommunity on Twitter for updates
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2015 MEMBER APPLICATION The P&G Cincinnati MLB Urban Youth Academy provides FREE year-round Baseball and Softball training for underserved Boys and Girls ages 5–18 residing primarily in urban neighborhoods in the Greater Cincinnati & Northern Kentucky Area. CHILD INFORMATION: Child’s Name: _____________________________________________________________________________________________ Home Address: _____________________________________________________________________________________________ City:
_______________
Home Phone:
State:
___Cell Phone:__ ___
School (for the 2015 year):
County:
_______ ____ ___Zip: _______________
_________ Email: _________________________________________ _________________________________Grade:
Birth Date:
/
/
Age (As of June 1, 2015) :
Gender:
T-Shirt Size:
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
Adult XL
Male
Female
Adult XXL
DEMOGRAPHICS: ** The following information is necessary for our records and the funding our organization receives. The answers you provide are completely confidential. Your cooperation in providing this information is both appreciated and necessary. ** Ethnicity Household Income Member Lives With/Household Type (check all that apply) Black
under $10,000
Both Parents
Guardian
Other:____________
White
$10,000-$14,999
Single Parent Family
Grandparents
__________________
Hispanic
$15,000-$19,999
Mother
Extended Family
__________________
Asian
$20,000-$24,999
Father
Foster Family
__________________
Native American
$25,000-$29,999
Number of Individuals Living in Household:____________________________
Appalachian
$30,000-$34,999
Is member a U.S. Citizen?
Multi Racial
$35,000 and above
Other
Yes
No
If no, please list Nationality______________________________________ Is parent/guardian a member of the military? Yes No If yes, which branch? ___________________________________________ Does your child qualify for free or reduced-price meals at their school? Yes
No
Program not offered
Choose not to answer
Reds Community Fund Outreach Programs Has your child previously participated in the following programs? (Please select all that apply)
Reds Rookie Success League
Reviving Baseball in Inner Cities (RBI Program)
Match Program
Reds Urban Youth Academy Clinics or Open Gym
Enrollment is LIMITED. Applications will be taken on a “First come, first served” basis. Applications can be returned to the address listed below or at
[email protected]. Baseball and Softball Equipment can be provided. 2026 E. SEYMOUR AVENUE, CINCINNATI, OH 45237
For more information please visit reds.com/academy or contact Cameron Satterwhite at (513) 765-5000 or Fax to (513) 3512067 Email:
[email protected]/Follow @RedsCommunity on Twitter for updates.
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This Binding Agreement Must Be Completed by Parent(s)/Guardian(s) Before Participation in the P&G Cincinnati MLB Urban Youth Academy CONDITIONS OF REGISTRATION: RELEASE OF LIABILITY/INFORMED CONSENT/ASSUMPTION OF RISK WAIVER (Child’s Name) desires to participate in the P&G Cincinnati MLB Urban Youth Academy. I and my child are fully aware of the fact that there are special dangers and risks associated with participation in any activity, including but not limited to the potential for falls, slips, sprains, broken bones, extreme physical contact with other participants or outbursts of rage by other players, coaches or referees. In extremely rare cases, paralysis and even, sudden death can occur as a result of participation in this activity. Serious injury may also occur as a result of certain playing conditions such as potholes and standing water on fields along with humidity, heat, cold and other weather conditions inherent with games played outdoors. Serious injury may also occur as a result of certain playing conditions inherent with games played indoors. Serious injury or sudden death may also occur as a result of improper use of equipment. I further acknowledge and agree that none of the Released Parties (as defined below) has any obligation or responsibility to evaluate my child’s physical condition or any limitations associated with his/her participation in the Activities. I certify that I am the parent/legal guardian of the above-named child; that I have read and understand this Release of Liability and Assumption of Risk Agreement.. I further represent and warrant that I am at least eighteen (18) years of age. I certify that I have explained the risks and dangers to my child. I hereby release and hold harmless the Cincinnati Recreation Commission, Boys and Girls Clubs of Greater Cincinnati, Cincinnati Public Schools, YMCA of Greater Cincinnati, Procter and Gamble, the City of Cincinnati, Major League Baseball, the Cincinnati Reds LLC. and Cincinnati Reds Community Fund and their respective affiliates, subsidiaries, coaches, volunteers, medical personnel, security officers, administrative officials, other employees, volunteers, owners, officers, directors and agents from any liability, actions, causes of action, claims, judgments cost or expense, including attorney fees, known or unknown at this time, arising out of or in any way related to any injury or illness incurred by my child while participating in, or traveling to and from any practice, game, or special event. I have voluntarily chosen to allow my child to participate and assume all such dangers and risks. I request that my son/daughter be permitted to participate in P&G Cincinnati MLB Urban Youth Academy.
IN ADDITION, ON MY BEHALF AND ON BEHALF OF MY CHILD, I HEREBY WAIVE ANY CLAIMS AGAINST THE RELEASED PARTIES THAT I MAY HAVE ARISING FROM MY CHILD’S PARTICIPATION IN THE ACTIVITIES. ON MY BEHALF AND ON BEHALF OF MY CHILD, I FURTHER COVENANT AND AGREE NOT TO SUE THE RELEASED PARTIES FOR ANY CLAIMS OR DAMAGES ARISING FROM MY CHILD’S PARTICIPATION IN THE ACTIVITIES. I accept full responsibility for my child’s medical bills, if any, and all other associated expenses as a result of injures or illness sustained while my child is participating in P&G Cincinnati MLB Urban Youth Academy. The above-named student for whom I am the parent or legal guardian is in good physical and mental health and does not suffer from any mental or physical condition or disability that might render participation in the baseball academy hazardous to him/her or to others. Permission for school to release grades, attendance, promotion and discipline data. By signing below, I acknowledge that I have read this release of liability in its entirety and understand this Release of Liability and Assumption of Risk Agreement and sign it freely.
Parent/Guardian Name, unless participant is 18 years old:
(Please Print)
USE OF LIKENESS I authorize the Cincinnati Reds Community Fund, The Cincinnati Reds LLC, the Cincinnati Recreation Commission, Boys and Girls Clubs of Greater Cincinnati, Cincinnati Public Schools, YMCA of Greater Cincinnati, to use my child’s voice and likeness in any media now known or hereafter created, worldwide in perpetuity without further compensation. The aforementioned parties are not obligated to use any of the above mentioned materials, but may do so and may edit such information of materials in respective their sole discretion, without further obligation or compensation. I have read fully and fully understand this release form. Before registration in this program is valid, this release form must be signed by the participant’s parent or legal guardian. Signature of Parent/Guardian: ____________________________________________________Date:_______/________/________
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CONDITIONS OF REGISTRATION CONTINUED: Emergency Medical Authorization Registration or entry into the Reds Rookie Success League program constitutes agreement to the following conditions: Allergies
no
yes
Please specify ____________________________________________________
Medications
no
yes
Please specify ____________________________________________________
Medical Conditions: no yes Please specify ____________________________________________________ Other Issues or required assistive devices: ________________________________________________________________________ My child needs an accommodation because of disability to participate in or enjoy the program. (If yes, you will be contacted for additional information.) no yes Doctor’s Name: ___________________________________________ Phone:________________________________________ Hospital/Clinic: ____________________________________________ Phone: ________________________________________ Health Insurance Name: _____________________________________ Phone: ________________________________________ Health/Medical Insurance ID or Group # __________________________________________________________________________ Consent and Approval of Medical Treatment: In the event my child is in need of medical attention, I hereby give my consent for the administration of any treatment deemed necessary by a licensed physician and, if necessary, the transfer and treatment of my child to the nearest medical facility. Signature of Parent/Guardian: _________________________________________________Date:_______/________/________ OR
REFUSAL of Medical Treatment: I do not give my consent for medical treatment of my child. In the event of illness or injury requiring, medical attention, the Cincinnati Reds Community Fund shall take no action, or (if specified) to take the following action (specify action to take):________________________________________________________________________________________ Signature of Parent/Guardian: ____________________________________________________Date:_______/________/________ EMERGENCY CONTACT INFORMATION: Who should be listed as the primary contact?:
Father
Mother
Guardian
Other __________________________
Father Name: ____________________________________ Email: ____________________________________________________ Home Phone: ___________________________Work: ___________________________Cell: ________________________________ Mother Name: ____________________________________ Email: ___________________________________________________ Home Phone: ___________________________Work: ___________________________Cell: ________________________________ Guardian Name: __________________________________ Email: ____________________________________________________ Home Phone: ___________________________Work: ___________________________Cell: ________________________________ Additional contact if parents/guardians cannot be reached Name: _____________________________________________ Phone: ____________________ Relationship:__________________
URBAN YOUTH ACADEMY ANTI-HARASSMENT POLICY The Urban Youth Academies and Major League Baseball are committed to providing an environment in which everyone is treated with respect and dignity. We believe that athletes, coaches and staff have the right to pursue sports activities in an atmosphere free from inappropriate conduct, including sexual harassment. Sexual harassment and other inappropriate conduct towards athletes deter those affected from participating in sports programs and from developing both as athletes and as individuals. Sexual harassment among employees or coaches harms our efforts to create a work environment in which everyone has equal opportunity to succeed. Such inappropriate conduct violates our Academy’s and Major League Baseball’s policies and our commitment to providing a respectful athletic environment. Further, sexual harassment is illegal under various federal and state civil laws and can also violate criminal laws and result in individual liability. The following are examples of conduct that will not be tolerated at the Urban Youth Academy:
Making verbal or physical sexual advances, repeatedly standing too close or brushing up against another, or touching or grabbing another in a sexual manner;
Making sexually explicit gestures or comments toward others, whether or not in a joking manner;
Making, showing or distributing sexually explicit, demeaning or offensive pictures, cartoons, writings or other materials, whether in person, by e-mail, via social media, or by texting;
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Sexually explicit pranks, or repeated sexual teasing;
Spreading rumors about, or otherwise commenting on, another’s sexuality or appearance;
Giving sexually suggestive gifts or leaving objects that are sexually suggestive; and
Exerting pressure on others for sexual favors, or repeatedly asking a colleague to socialize off-duty when he or she has declined.
If you know (or have a reasonable cause to believe) that anyone associated with the Academy programs has engaged in any form of inappropriate conduct under this policy (whether listed above or otherwise), or that such conduct has occurred in or around any property utilized by the program or an event sponsored by the program, immediately report the conduct to the Academy director or a Coach. A "reasonable cause to suspect" does not require conclusive proof; you should be guided by principles of common sense and good judgment. Employees and athletes will not be punished or retaliated against for making a good-faith report. Violation of this policy may subject an employee to discipline up to and including immediate termination. Any disciplinary action taken by the Academy does not depend on whether civil or criminal charges are filed against the individual in question. If an athlete violates this policy, he or she may also face discipline, up to and including expulsion from the Academy program. If you have questions about this policy, please direct them to the Academy’s program director Anti-harassment Training Consent Form The Major League Baseball Urban Youth Academy is committed to providing an athletic environment in which everyone is treated with respect and dignity. We believe that all athletes have the right to pursue sports activities in an atmosphere that discourages inappropriate conduct, including sexual harassment. As a part of our player anti-harassment training, we have developed two videos that are designed to raise Academy participants’ awareness of sexual harassment in an age-appropriate way. One video is for those 5 to 12 years old and the other is for those 13 to 18 years old. Both videos stress the Academy's focus on baseball-related activities, inform participants about appropriate vs. inappropriate touching, and explain what to do if an incident occurs.
As the parent/guardian of an Academy player, by checking this box and signing below, I acknowledge that I am voluntarily granting permission for the Academy to show the age-appropriate Anti-Harassment training video to the player for whom I am legally responsible.
As the parent/guardian of an Academy player, by checking this box and signing below, I am denying permission for the Academy to show any Anti-Harassment training video to the player for whom I am legally responsible, and I hereby release, forever discharge and covenant not to sue the Academy, the Reds Urban Youth Academy, the Office of the Commissioner of Baseball and all of their respective related entities, subsidiaries, affiliates, officers, directors, partners, owners, shareholders, agents, employees, volunteers, successors, and assigns. The foregoing shall constitute a release and waiver of all liability, claims, demands, losses, or damages of whatever kind or nature, either in law or in equity, on my account arising from my player’s participation in the Academy. Printed Name of Player: _________________________________________________________ Printed Name of Parent/Guardian: ___________________________________________Date:_______/________/________ Signature of Parent/Guardian or Player if 18 and over
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