o Coach Pitch (3rd-4th Grade) o Modified Pitch (5th-8th Grade) Child’s Name: _____________________________ Birthday: __________________ Boy: ______ Girl: ______ Grade (2016-17): ________ Parents Name: ________________________________________________________ Home Phone #: _______________________ School: _________________________ Mom’s Cell #: ____________________ Dad’s Cell #: ________________________ Address: _______________________ City/State/ZIP: _______________________ E-mail: ______________________________________________________________ Shirt Size: oYouth M oAdult S oAdult L oYouth L oAdult M oAdult XL I would like to Buddy with: _____________________________________________ Get Kids Connected: o$1 o$5 o$10 o$25 o$____ Would be available to: ______Head Coach ______Assistant Coach ______No Depending on the number of coaches volunteering in each age group, placement as a coach is not guaranteed. By my signature on this form, I waive and release any and all rights to institute a claim against the City of Gladstone for any damages or injuries to my child which are not a result of negligence on the part of the City of Gladstone, their agents or employees, or any costs resulting therefore, in conjunction with my child’s participation in the City of Gladstone Coach or Modified Pitch Rotational Softball Program. Signature of Parent/Guardian: __________________________________________ Payment: oMasterCard oVisa oDiscover oCash oCheck oMoney Order Card #: ____________________________________________ Exp. Date: ______ Return this form to: Gladstone Parks & Recreation Department Attn: Coach or Modified Pitch Softball 6901 N. Holmes Gladstone, MO 64118 Please make checks payable to City of Gladstone.

Coach or Modified Pitch Registration - $71 (Buddy Form on back. Buddy applications must be submitted together)

City of Gladstone • 6901 N. Holmes • Gladstone, MO 64118 (816) 423-4200

www.gladstone.mo.us

2016 Youth Coach or Modified Pitch

Rotational Softball

Gladstone Parks & Recreation

Coach or Modified Pitch Rotational Softball The Gladstone Parks & Recreation Department is sponsoring a Summer 2016 Youth Coach & Modified Pitch Rotational Softball league for kids. The divisions will be Coach Pitch for 3rd - 4th grades and Modified Pitch for 5th - 8th grade. Coed games will be played in both age groups. Registration for this program is $71 per player. Grades are based on the 2016 - 2017 school year. Registration Procedures - Registrations will be accepted beginning Monday, March 28th until Friday, May 20th or until leagues are filled (which ever occurs first). Complete the attached form and return it along with payment to: Gladstone Parks & Recreation Department Attn: Coach or Modified Pitch Rotational Softball 6901 N. Holmes Gladstone, MO 64118 Payment must accompany form. Telephone registrations will not be accepted. You can now register online at www.activityreg.com “Buddy System” - Invite a friend (or a car pooling buddy) from your same division and they will automatically be placed on the same team with you. “Buddy” applications must be submitted together, along with the proper registration fee. Team Selection - Teams will be chosen by means of random selection. Children of the coach and 1 assistant coach and their “buddies” will automatically be placed on the same team. Names of all other players shall be drawn randomly with siblings being “buddies” (if they are in the same division). Coaches may bring up to 8 players on a team. Teams will consist of up to 12 players. Practice/Games - All practices and games will be held at Happy Rock Park Softball Complex, 76th and North Antioch. Practices will be held on Tuesdays anytime between 6:00 p.m. - 8:00 p.m. for the 3rd - 4th grade division and anytime between 6:00 p.m. - 9:00 p.m. for the 5th - 8th grade division beginning Tuesday, May 31st. Games will be on Fridays at either 6:30 p.m. or 7:45 p.m. starting June 17th. Practices will be held on the following Fridays: June 3rd and June 10th. Volunteer Coaches - All teams are coached by parent and community volunteers. Coaches are always needed in all divisions. Our department conducts coaches training clinics, therefore, minimal softball knowledge is necessary to volunteer. Teams not having coaches will not practice until an individual willing to coach steps forward to do so. Get Kids Connected - By contributing $1 or more when you pay your registration, you can give your neighbors in need a helping hand. Gladstone Parks & Recreation maintains a scholarship fund to help northland youth who do not have the financial means to partici-pate in recreation programs. This scholarship program is made possible through dona-tions from businesses and individuals throughout the northland. Scholarships are offered to interested youth and available for designated programs offered by Gladstone Parks & Recreation. Get Kids Connected is a 501c(3) and is tax deductible.

o Coach Pitch (3rd-4th Grade) o Modified Pitch (5th-8th Grade) Child’s Name: _____________________________ Birthday: __________________ Boy: ______ Girl: ______ Grade (2016-17): ________ Parents Name: ________________________________________________________ Home Phone #: _______________________ School: _________________________ Mom’s Cell #: ____________________ Dad’s Cell #: ________________________ Address: _______________________ City/State/ZIP: _______________________ E-mail: ______________________________________________________________ Shirt Size: oYouth M oAdult S oAdult L oYouth L oAdult M oAdult XL I would like to Buddy with: _____________________________________________ Get Kids Connected: o$1 o$5 o$10 o$25 o$____ Would be available to: ______Head Coach ______Assistant Coach ______No Depending on the number of coaches volunteering in each age group, placement as a coach is not guaranteed. By my signature on this form, I waive and release any and all rights to institute a claim against the City of Gladstone for any damages or injuries to my child which are not a result of negligence on the part of the City of Gladstone, their agents or employees, or any costs resulting therefore, in conjunction with my child’s participation in the City of Gladstone Coach or Modified Pitch Rotational Softball Program. Signature of Parent/Guardian: __________________________________________ Payment: oMasterCard oVisa oDiscover oCash oCheck oMoney Order Card #: ____________________________________________ Exp. Date: ______ Return this form to: Gladstone Parks & Recreation Department Attn: Coach or Modified Pitch Softball 6901 N. Holmes Gladstone, MO 64118 Please make checks payable to City of Gladstone.

Coach or Modified Pitch Registration - $71 (Buddy Form on back. Buddy applications must be submitted together)