FOR OFFICE USE ONLY:
2015 Spring Football Registration
DATE REGISTRATION RECEIVED:
PO Box 44127 – 2947 Tillicum Road
Victoria BC, V9A 7K1
Website: www.victoriafootball.ca
Today’s Date:
TEAM/PARK/DIVISION:
Returning Player: Yes
No
**New Players: How did you hear about Greater Victoria Minor Football?
Player Name:
LAST
Player Address:
Players Date of Birth:
City:
FIRST
MIDDLE INITIAL
PostalCode:
1st Contact Phone #:
Alternate #:
DD/MMM/YYYY
Parent/Player Contact Email(s):
Mother:
Father:
Resides with:
Both Parents
Mother
Name of School:
Guardian:
Father
Mother/Father
Home Schooled (Y/N):
Guardian
Current Grade:
*The GVMFA enforces its boundaries. You must play for the park in the district you live or in the district of the school you attend. Any exceptions to
this must be approved by the Board of Directors. Please attached a request letter to your registration to apply for any change of park.
Park & Division you are registering for:
GordonHead:
Peninsula:
Saanich:
Sooke:
Victoria:
Westshore:
PreAtom (Born 2005, 2006, 2007)
PreAtom (Born 2005, 2006, 2007)
PreAtom (Born 2005, 2006, 2007)
PreAtom (Born 2005, 2006, 2007)
PreAtom (Born 2005, 2006, 2007)
PreAtom (Born 2005, 2006, 2007)
Atom (Born 2003 & 2004)
Atom (Born 2003 & 2004)
Atom (Born 2003 & 2004)
Atom (Born 2003 & 2004)
Atom (Born 2003 & 2004)
Atom (Born 2003 & 2004)
PeeWee (Born 2001 & 2002)
PeeWee (Born 2001 & 2002)
PeeWee (Born 2001 & 2002)
PeeWee (Born 2001 & 2002)
PeeWee (Born 2001 & 2002)
PeeWee (Born 2001 & 2002)
2015 Registration Fees and Requirements
PreAtom $250 (
$225 Early Registration Discount if received in full by Jan.31st 2015)
Cash Received or Cheque # :
Atom
$250 (
$225 Early Registration Discount if received in full by Jan.31st 2015)
Cash Received or Cheque # :
PeeWee $250 (
$225 Early Registration Discount if received in full by Jan.31st 2015)
Cash Received or Cheque # :
Gear Deposit Cheque** in the amount of $300.00 post-dated June 25, 2015
Cheque #:
Jersey Deposit Cheque** in the amount of $100.00 post-dated June 25, 2015
Cheque #:
**Deposit cheques will be returned to you when gear is returned, cleaned, at the end of the season.
Please make your cheques payable to: Greater Victoria Minor Football Association. (not GVMFA)
Signed Registration Waiver (pg6)
Signed Player AND Parent Code of Conduct form (pg6)
Signed Concussion Info/Recognition Form (pg6)
Photo Consent, First Aid/Volunteer Info (pg6)
Photocopy of Birth Certificate, Care Card or Passport
Please submit pages 1&6, keep pages 2-5 for your reference.
Applying for Registration Assistance? Links to assist programs can be found on the league website registration page:
KidSport*;
Langford Sport Assist;
Jumpstart;
Athletics4Kids;
* If applying for KidSport, please fill out the online registration or attach a completed KidSport application with your registration form. GVMFA will mail & process
your application. KidSport is a proud sponsor of the Greater Victoria Minor Football Association. KidSport and other Sport Assist programs eliminate the financial
barriers to sport participation. KidSport is a community based sport charity that provides grants for children age 6 to 18. A Gear Deposit cheque is still
required.
Page 2
GREATER VICTORIA MINOR FOOTBALL ASSOCIATION
REGISTRATION FEES
Registration Fees: Must be paid in full by April 20th, 2015. If registration fees have not been paid in full by April 20 th 2015, and
no arrangements have been made otherwise, the player will no longer be able to attend practices and games until resolved. If
full payment is not received within 10 days of verbal or written (email) past due notification, the player will be deemed to have
withdrawn and their gear must be returned.
Dishonoured Cheques: A $25.00 fee will be charged on all dishonoured cheques returned by the bank for any reason. A
cheque issued for registration, or skills camp, which is dishonoured will result in the player no longer able to attend practices
and games until resolved. If full payment plus the $25 charge back fee is not received within 10 days of verbal or written
(email) notification of the dishonoured cheque, the player will be deemed to have withdrawn and their gear must be returned.
REFUND POLICY
The Greater Victoria Minor Football Association is a non-profit, minor sports organization, part of the BC Community Football
Association. Every GVMFA registered player is also registered with BCCFA and is insured through a general insurance policy
held by Football BC. As there is a processing cost, a registration and an insurance cost incurred by GVMFA for every player,
no one will receive a “full refund”.
A player who withdraws from GVMFA Football before the second regular season game will receive a refund of registration
paid, less $40 for insurance paid and registration processing.
There will be NO Refunds after the second regular season game. For special circumstances, such as medical reasons, prorated refunds may be available upon request.
PLAYER & PARENT/GUARDIAN Code of Conduct
ALL Players & Parents/Guardians must read the following Code of Conduct and acknowledge so by
signing on page 6 on the registration package.
FOOTBALL IS A PHYSICAL AND OFTEN EMOTIONAL GAME. GOOD SPORTMANSHIP IS IMPORTANT AND IS
EXPECTED FROM ALL PLAYERS ON AND OFF THE FIELD. THE FOLLOWING IS THE STANDARD THAT ALL
PLAYERS AND PARENTS MUST ABIDE BY AS A PARTICIPANT AND A SPECTATOR IN THE GREATER VICTORIA
MINOR FOOTBALL ASSOCIATION.
1. Players and Parents/Spectators must not use any profane or vulgar language at any time, any place during practices
and games.
2. Players and Parents/Spectators must be 100% respectful of team-mates, coaches, officials and teams you play against.
No back talk or trash talk will be tolerated.
3. Players and Parents/Spectators must strive to support and encourage your team-mates at all times. No bullying will be
tolerated.
4. Players must wear their complete set of football gear including mouth guards for all practices and games.
5. Players shall strive to be on time for practices and games. If you are unable to attend, you must contact your coach
or team manager.
6. Players will always bring their own bottle of water or sports drink to practices and games. Hydration is important!!
7. Greater Victoria Minor Football Association has a zero tolerance for smoking, possession of or consumption of alcohol or
drugs by players or parents/spectators etc. at all practices and games.
8. Players and Parents/Spectators shall remember that winning is not everything and that learning the fundamentals of
football, developing skills and displaying great sportsmanship are the guiding principles of the Greater Victoria Minor
Football Association.
Always keep up with your schoolwork and concentrate on your grades. Nothing is more important than getting a
good education. Please ensure that you schedule enough time to do your homework AND attend football practices &
games.
Page 3
We Run On Volunteers
There are no pay cheques in this organization – we all care for our kids and that’s why we are here – to bring the best football
experience for everyone!
Code of Conduct
Every player, every coach, every parent and every volunteer should always be treated with respect and courtesy.
No angry outbursts directed at a coach, manager, official, player or any volunteer will be tolerated or engaged. The best rule is:
if you are upset about something, give it 24 hours then contact the manager or coach with your concern – the same applies to
emails – cool off, think and then respond.
Do not shout or give any instructions to officials If it’s a bad call TOO BAD – move on. Life is about learning from
mistakes and this especially applies to our young officials and players.
All of us care about our players very, very much – we as a group will always endeavour to treat every player fairly and keep
them safe. Any information from a parent that can help this objective is enthusiastically welcomed.
If a point of contention comes up, if you feel you have a concern that has to be heard or whatever the case may be, please
remember to respect each other – we are all here for the same reason.
Respect the officials at the game, please remember when you are cheering that these are grade school children on both sides
of the ball who are playing this game – what you say and how you say it stays in a child’s memory for a long time.
In many ways, we are in the memory business and it is absolutely crucial
that we all strive to give the best memories to our young players and
officials; it gives them a great childhood and it makes them want to give
their children the same experience in their adult life. It’s the positive energy
that gives this program a sound future.
Page 4
CONCUSSION INFORMATION SHEET
A concussion is a brain injury and all brain injuries are serious. They are caused by a bump,
blow or jolt to the head, or by a blow to another part of the body with the force transmitted to
the head. They can range from mild to severe and can disrupt the way the brain normally
works.
Even though most concussions are mild, all concussions are potentially serious and may
result in complications including prolonged brain damage and death if not
recognized and managed properly.
In other words, even a “ding” or a bump on the head can be serious. You can’t see a
concussion and most sports concussions occur without loss of consciousness. Signs and
symptoms of concussion may show up right after the injury or can take hours or days to fully
appear. If your child reports any symptoms of concussion, or if you notice the symptoms or
signs of concussion yourself, seek medical attention right away.
Symptoms may include one or more of the following:


Headaches

Amnesia

“Pressure in head”

“Don’t feel right”

Nausea or vomiting

Fatigue or low energy

Neck pain

Sadness

Balance problems or dizziness

Nervousness or anxiety

Blurred, double or fuzzy vision

Irritability

Sensitivity to light or noise

More emotional

Feeling sluggish or slowed down

Confusion

Feeling foggy or groggy

Concentration or memory problems

Drowsiness
(forgetting game plays)

Change in sleep patterns

Repeating the same
question/comment
Signs















observed by teammates, parents and coaches include:
Appears dazed
Vacant facial expression
Confused about assignment
Forgets plays
Is unsure of game, score, or opponent
Moves clumsily or displays lack of coordination
Answers questions slowly
Slurred speech
Shows behaviour or personality changes
Can’t recall events prior to hit
Can’t recall events after hit
Seizures or convulsions
Any changes in typical behaviour or personality
Loses consciousness
Page 5
What can happen if my child keeps on playing with a concussion or returns too soon?
Athletes with the signs and symptoms of concussion should be removed from play
immediately. Continuing to play with the signs and symptoms of a concussion leaves the
young athlete especially vulnerable to greater injury. There is an increased risk of significant
damage from a concussion for a period of time after that concussion occurs, particularly if the
athlete suffers another concussion before completely recovering from the first one. This can
lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with
devastating and even fatal consequences. It is well known that adolescents or teenage
athletes will often under report symptoms of injuries and concussions are no different. As a
result, education of administrators, coaches, parents and students is the key for studentathletes’ safety.
If you think your child has suffered a concussion
Any athlete even suspected of suffering a concussion should be removed from the game or
practice immediately. No athlete may return to activity after an apparent head injury or
concussion, regardless of how mild it seems or how quickly symptoms clear, without medical
clearance. Close observation of the athlete should continue for several hours.
The new Football BC policy now requires the consistent and uniform implementation of
long and well-established return-to-play concussion guidelines. The complete Football BC
concussion policy can be downloaded at playfootball.bc.ca/files/FBCConcussionPolicy2012.pdf.
You should also inform your child’s coach if you think that your child may have a concussion.
Remember, it’s better to miss one game than miss the whole season and…
When in doubt, sit them out.
For current and up-to-date information on
concussions, please visit www.thinkfirst.ca and
http://brain101.orcasinc.com/5000/
www.playfootball.bc.ca
Phone: 604.677.1025
Office Address: #222 – 6939 Hastings, Burnaby, BC Mailing
Address: #434 6540 Hastings, Burnaby, BC, V5B 4Z5
[email protected]
facebook.com/footballbc | twitter.com/football_bc
Page 6
1. 2015 GVMFA REGISTRATION WAIVER:
I,
, the parent/guardian of the player,
, do
hereby release the GVMFA coaches, trainers and league volunteers from all liability, and I waive, as against the said
coaches, trainers and league volunteers, all claims of any kind whatsoever that I might have for any and all illness,
injuries, and/or losses suffered or sustained by the said player through participation in activities of the Greater Victoria
Minor Football Association.
Parent/Guardian Signature:
Date:
Does the registered player have any Medical Conditions:
Yes
No IF yes, please provide details:
2. 2015 Parent & Athlete Concussion Info/Recognition & Acknowledgement
Player Name (printed):
Player Signature:
Date:
Parent/Legal Guardian Signature:
Date:
By signing above, the signees acknowledge they have read the Football BC concussion policy provided with
registration and understand the risk of head injuries associated with playing a contact sport. The signees also
agree to abide by all the guidelines set out by the Football BC concussion policy.
Please keep the Concussion Information Sheets, pages 4 & 5 of the registration package, for your reference.
3. Code of Conduct, Fees & Refund Info
I/we have read the Greater Victoria Minor Football Association Code of Conduct on pages 2 &3 and hereby agree to be
bound by its terms. I/we have read the Registration Fees and Refund Policy on page 2 and agree to be bound by
their terms. Please keep the Code of Conduct Information Sheets, pages 2 & 3 of the registration package, for your reference
Player Signature:
Date:
Parent Signature:
Date:
4. 2015 Photo Release
Yes, I grant permission for my child's photo to be used on the Greater Victoria Minor Football Association’s
website, Social Media sites and/or local Newspapers.
No, I do not grant permission for my child's photo to be used on the Greater Victoria Minor Football
Association’s website, Social Media sites and/or local Newspapers.
Parent/Legal Guardian Name (printed):
Date:
Parent/Legal Guardian Signature:
5. Volunteer Info
The Greater Victoria Minor Football Association runs on volunteers; from the stick crew at games, team managers &
coaches to board members. All our children are very fortunate to have such dedicated volunteers that keep this league
running but we could always use more help!
Parents/Guardians & older siblings (15+):
Do you have valid First Aid?
Yes
No
Are you willing to volunteer as a coach or team trainer?
Are you interested in helping with: UBC Skills Camp?
Yes
No
Divisional Jamboree?
Are you interested in helping with the Annual GridIron Get Together and other league wide fundraisers?
Specific contact info for volunteering (email and/or phone):
Yes
No
Yes
No
Yes
No