LITTLE STRIKERS Soccer 2023

LITTLE STRIKERS Soccer 2023

The LITTLE STRIKERS program is exclusive to boys and girls in PreK-1st grades who live in the 74127 zip code
Our Little Strikers will learn soccer skills through fun activities. Learning games designed specifically for this young age group.

PreK - 1st Graders

- Practices at The HUB on Fridays / 5:30-6:30pm

The HUB fields are located at 19 S. 49th West Ave.

- Program runs for 6 weeks:
- March 31, April 7, 14, 21, 28, May 05

Participants should wear sneakers and comfortable athletic clothing you can easily move in.

*Tshirts & Snacks are provided by The Common Good

NOTE: This program is for those that live in the 74127 zip code ONLY.

Questions? Email Athletics Program Manager,
Massiel Anguiano at massiel@cgtulsa.org
Child's name:*

First NameLast Name
Child's gender:*

MaleFemale
Child's Tshirt size:

Youth SmallYouth MediumYouth LargeYouth XLarge
Child's birthday:*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's current grade in school:*
Name of school (if any):
Parent / Legal Guardian:*

Full NameRelation to Child
Parent / Legal Guardian Phone Number:*
Please enter a valid phone number.
Parent / Legal Guardian #2:

Full NameRelation to Child
Parent / Legal Guardian #2 Phone Number:
Please enter a valid phone number.
Parent / Legal Guardian #3:

Full NameRelation to Child
Parent / Legal Guardian #3 Phone Number:
Please enter a valid phone number.
Parent / Guardian email(s):
Please enter a valid email address.
Parent comments/concerns (if any):
Other than yourself, please list who CAN pick up your child. Please list NAME, RELATION TO CHILD, PHONE #.*
Person who CANNOT pick up your child and why. Note: If you have a restraining/protective order against this individual, please bring it upon pickup on the first day of programming so we can make a copy for our records.
Do you have a restraining/protective order on this person?
Additional Person who CANNOT pickup your child and why.
Do you have a restraining/protective order on this person?
Does your child currently participate in activities at The HUB and has already completed medical information & media release?*

Yes, my child is in the Learning Center and/or C.H.A.M.P.S. (if yes, skip to last page)Yes, my child is involved in the Middle School programs (if yes, skip to last page)No > please continue to Medical Release Form

MEDICAL RELEASE AND AUTHORIZATION FORM
Child's Name:
Family Physician:
Physician Phone #:
Please enter a valid phone number.
Allergies:
Currently taking the following medication & reason for taking medication:
Medical Insurance Company (if any):
Policy #:
Phone Number:
Please enter a valid phone number.
Family Dentist:
Dentist Phone Number:
Please enter a valid phone number.
Dental Insurance Company (if any):
Policy #:
Phone Number:
Please enter a valid phone number.
In case of emergency, I hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

This authorization and permission form is valid for all The Common Good activities for the 2022-2023 school year & Summer 2023.
Parent / Guardian Signature:

Clear
Date (MM/DD/YYYY):

Release Form for Media Recording

I, the undersigned, do hereby consent and agree that The Common Good, its employees, Board members, volunteers, and agents have the right to take photographs, videotape, or digital recordings of me and use these in any and all media, now or hereafter known, and exclusively for the purpose of advertising or promoting The Common Good or any entities with which we partner. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to The Common Good, its Board, employees, volunteers, and agents all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either now or in the future.

I also understand that The Common Good is not responsible for any expense or liability incurred as a result of my participation in this recording.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

If not 18 years of age, Parent/Guardian Name signature is required at the bottom.
Parent/Guardian Signature:

Clear
Date:
NO. I do not give permission for media release. Please contact me to discuss.

THE COMMON GOOD

RELEASE OF LIABILITY FORM

In consideration of my child participating in The Common Good Athletic Programs, We/I, do for ourselves (myself) and for and on behalf of my/our child-participant do hereby release, forever discharge and agree to hold harmless The Common Good and its employees, Board members, volunteers, and agents thereof from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and child-participant that occur while said child is participating in the activity sponsored by The Common Good.

Furthermore, We/I and for and on behalf of our/my minor child-participant if under the age of 21 years hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participating in recreation and work activities involved therein.

The undersigned further hereby agree to hold harmless and indemnify The Common Good, its employees, board members, volunteers, and agents, for any liability sustained by The Common Good as the result of the negligent, willful or intentional acts of said participant, including expenses incurred attendant thereof.
Parent / Guardian Signature:*

Clear
Date (MM/DD/YYYY):*
IMPORTANT INFORMATION

Check-in/Check-out Procedures, Transportation, Authorization for Pick-up

Parents/legal guardians will identify on their child’s registration form who can and cannot pick up their child. The HUB is dedicated to the safety of the children in our program and will be requiring adults to show their ID upon pickup.

If a parent or legal guardian wishes to add more people to the “Can pick up” or “Cannot pick up” list, they will need to provide the notice in writing, by delivery or email to massiel@cgtulsa.org. This policy is in place to maintain the safety of the children in our Basketball Camp.

The Common Good uses a checkout system to ensure that every child is picked up by a safe and approved individual. Children will not be allowed to leave The HUB without an approved individual. Upon pick-up, a staff member or volunteer will require that each individual show proper identification to ensure they are on the “List of people who can pick up my child(ren).” We take very seriously the safety of the children in our programming and will not release a child to any individual we do not recognize without a proper identification card.

Supervision

Children will be well supervised, and trained staff and volunteers will remain with children at all times.

Care of Children Who Are Ill

Children who become ill while in our care may be sent home if:

•       The child’s illness is keeping him or her from comfortably taking part in the basketball activities.

•       The sick child needs more care than the staff can provide without affecting the health and safety of other children.

•       Other children could get sick from being near the sick child.

• Child shows symptoms that could result in a positive COVID-19 test.

Emergency Preparedness

The HUB has developed and practices emergency plans for:

•       Serious injuries or illnesses

•       Lost or abducted child

•       Poison exposure, including exposure to toxic substances

•       Potentially violent situations in the program, including individuals with threatening behaviors

•       Natural disasters, including tornado, blizzard, flood, or earthquake - The Learning Center will not be in session if Tulsa Public Schools cancels school for bad weather.

•       Fires

•       Disruption of utilities, including loss of electricity, gas, water

Security

Entrances are protected from unauthorized visitors by remaining locked from the outside. During enrollment parents can write the names of adults who are not allowed to pick up their child(ren).

Methods of Communication

·       Feel free to share any concerns or questions that may arise.

·       You may call or text between 10am-7pm at 918-619-3861.

·       You can request a meeting with Athletics Program Manager, Massiel Anguiano, by emailing massiel@cgtulsa.org

Weapons

There are no weapons permitted at the facility. The HUB/Learning Center has a “No Weapons on Site” policy.

Confidentiality

Every child’s information will be kept confidential. The Common Good will not share a child or a family’s personal information unless child abuse or neglect is reported or suspected.

Review and Revision of Policies, Plans, and Procedures

The policies and procedures are revised and updated as we learn new information and as we receive input from families, so feel free to provide input or ask questions at any time.

I have gone over these policies and by signing this I agree to follow the policies set forth.
Signature of Parent/Guardian:*

Clear
Date:*
NO. I do not give permission. Please contact me to discuss.
Should be Empty: