NGAUA 2024 Registration Form

NORTH GEORGIA AMATEUR UMPIRE ASSOCIATION

2024 Registration
Name (REQUIRED)*

First NameMiddle NameLast NameSuffix
Address (REQUIRED)*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
PRIMARY Phone Number*

Area CodePhone Number
SECONDARY Phone Number (optional)

Area CodePhone Number
Date of Birth (REQUIRED)*

MonthDayYear
Referred by:
If someone referred you to NGAUA enter their name
Returning Umpires - Year you joined NGAUA
Under 16 and/or Junior Umpire Program (available only to in park players 14+)

NOT APPLICABLEWCGSCherokee RecOther - full Time - under 16
PARENT Name (REQUIRED)

Parent First NameParent Middle NameParent Last NameParent Suffix
PARENT Email (required)
example@example.com
PARENT Phone Number (required)

Area CodePhone Number
BACKGROUND CHECKS - All registrants of legal age will be background checked with USA Softball registration and/or local municipalities. IF YOU WILL NOT PASS A BACKGROUND CHECK CONTACT US BEFORE PROCEEDING

TERMS & CONDITIONS
- Any umpire who is reported by either park officials or a NGAUA Board member using a cell phone on a field will be suspended, without warning, a period of one calendar week effective the week following the incident being reported.
- I agree to attend all mandatory Rule & Fieldwork Clinics that are required by NGAUA that will qualify me to officiate this season.
- I understand that failure to attend required clinics, being late to assignments, being out of uniform or other conduct detrimental to NGAUA may result in reduced game assignments until resolved.
- I consent for NGAUA to use electronic methods to provide yearly 1099 Tax information.
- I understand that NGAUA supports the Special Olympics organization and that $20 will be deducted from my paychecks ($l0 per paycheck, typically April & May paychecks).
- Each member of NGAUA shall pay:
  - NGAUA membership dues as formulated by the Board of Directors to cover operating expenses.
  - Membership dues to affiliated Associations as applicable.
  - Liability Insurance fee as applicable.
  - A ten percent (10%) agent fee for each game officiated.
  - A late fee for registration at the cut-off date. Exceptions may be made for a transferee with approval by the Board of Directors.
All fees and dues shall be paid in full before a game assignment shall be made.

In the event of voluntary termination, suspension, or expulsion of a member, no refund of fees or dues shall be made.

Liability Release, Indemnity and Insurance Agreement
Effective Date: 01/01/2024
l, {namerequired3}, (herein after "Sports Official") hereby acknowledge and agree that entering and using a sports facility carries risks. Further, l acknowledge that umpiring or refereeing games or otherwise performing the duties of a Sports Official can result in injury to me and others, including as a result of the intentional wrongdoing of players or spectators. For and in consideration of the right to umpire or referee or otherwise serve as a Sports Official at an event scheduled by the North Georgia Amateur Umpire Association (NGAUA), I knowingly and voluntarily assume these and all other risks and hereby (a) agree to release, indemnify, defend and hold harmless the North Georgia Amateur Umpire Association (NGAUA), and its appointed and elected officials, departments, agencies, boards, commissioners, officers, agents, employees and volunteers (collectively the "Released Parties") from and against or with respect to any and all claims, injuries, suits, actions, judgments, damages, losses, costs, expenses and liability of any kind whatsoever (including but not limited to attorney's fees and costs of defense) (hereinafter "Liabilities") which may result from any cause whatsoever (including, without limitation, negligence in rendering, or not rendering, medical or emergency aid), for any and all loss of life, personal or bodily injury, property damage and/or other loss I or my minor children may suffer or incur as a result of or in relation my participation as a Sports Official, whether or not any such loss is caused in whole or in part by the action, inaction or negligence of any Released Party," and (b) waive any and all rights I or they may have to make a claim against or to sue any Released Party for any such loss of I/fe, injury, damage or other loss. l authorize representatives of the Released Parties to obtain emergency treatment for me in the event of injury or illness. It is also understood and agreed that this waiver, release and assumption of risk to be binding on my heirs and assigns. I understand that the Released Parties do not maintain health, medical, disability or workers' compensation insurance for my benefit and that I will be responsible for the cost of any medical services incurred by me unless l obtain my own insurance. Further, l agree to assume all responsibilities for any property damage or injury to any person caused by me while participating in being a "Sports Official'. l have read, and understand this liability release. If any provision hereof is found to be invalid or unenforceable, such determination shall not invalidate or render unenforceable any other provision of this Liability Release, Indemnity and Insurance Agreement.
Applicable Law

This contract shall be governed by the laws of the State of Georgia and any applicable Federal Law.
Name: {namerequired3} Phone: {primaryPhone5}

Address: {addressrequired4}

Date of Birth: {dateOf7}
Signature*

NORTH GEORGIA AMATEUR UMPIRE ASSOCIATION

REQUIRED INFORMATION for USA Softball Registration
Enter the information AS IT APPEARS on your Drivers License.

We are -NOT- collecting your drivers license number.

Only the state and expiration date
IF you are under 18 and do NOT have a driver's license just enter today's date as the expiration
Drivers License STATE
Drivers License Expiration Date
Should be Empty:

NORTH GEORGIA AMATEUR UMPIRE ASSOCIATION

NORTH GEORGIA AMATEUR UMPIRE ASSOCIATION