Hidden Listed below are the KidsPlay sports for 2022-23 and their scheduled dates for beginning and end of season. PLEASE NOTE: Dates may change
Check all that apply.
STUDENT INFORMATION School Year *
Please select the school year for which you are registering your son/daughter for the KidsPlay program.
2022 - 2023 Sport and Season Selection *
Click on the dropdown below to select the KidsPlay Sport and Season for which you are registering your son/daughter. The scheduled dates for the beginning and ending of the seasons are listed in parentheses by each sport.
Select Flag Football (Sep 6 - Oct 27) Cross-Country (Oct 31 - Dec 8) Basketball (Jan 23 - March 16) Olympic Handball (March 20 - May 25) Select the current LEARN Program you are enrolled in. * Select ASPIRE Before School ASPIRE After School Not in any of the above Student Name *
Name of Students School * Select Cherrylee Cleminson Columbia Cortada Durfee Gidley Le Gore New Lexington Potrero Rio Hondo Rio Vista Shirpser Wilkerson Wright Date of Birth *
MM slash DD slash YYYY
Grade Level * Select 3rd 4th 5th 6th 7th 8th Gender * Select Female Male Non-binary Other Prefer not to say Shirt Size *
* Home Phone Number *
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Cell Phone Number
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PARENT OR GUARDIAN INFORMATION Parent/Guardian Name 1 *
Parent/Guardian Address 1 (If different from student)
Parent/Guardian Email 1 * Parent/Guardian Mobile 1 * Parent/Guardian Home 1 * Parent/Guardian Name 2
Parent/Guardian Address 2 (If different from student)
Parent/Guardian Email 2
Parent/Guardian Mobile 2 Parent/Guardian Home 2 PARTICIPANT MEDICAL HISTORY & EMERGENCY INFORMATION
If your son/daughter is required to be administered medication during program hours, an “Authorization to Medicate” form must be completed and submitted to LEARN. The form requires the physician’s signature. A paper copy of this form can be obtained from the Site Coordinator. Please follow the completion instructions on the form.
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Medical Insurance * Policy Number * Medical Conditions * Allergies * Medications * EMERGENCY CONTACT AND ADULTS AUTHORIZED TO PICK-UP STUDENT
LEARN will include the names of both parents/guardians listed on this Registration Form as Authorized Adults in the student information system. LEARN will only remove a parent from the student information system with a legal document that instructs that action, such as valid court documentation that restricts a birth parent’s access to a child.
The parent or legal guardian of a student must authorize any other adults they will permit to take physical custody of their child when picking them up from the program. Such authorization must be provided on this form. All authorized adults will be entered into the student information system as being approved by the parent/legal guardian. Only the parent/legal guardian may request changes to the list of authorized adults in the student information system.
Authorized adults must produce valid, unexpired, photo identification to LEARN staff. Adults who are not able to produce valid identification will not be allowed to pick-up a student from the program, regardless of whether the adult’s name appears on this form or in the LEARN student information system as an emergency contact or authorized person.
It is the sole responsibility of the parent or legal guardian to ensure that LEARN has the correct information for Emergency Contacts and Authorized Adults.
Emergency Contact Name 1 *
Emergency Contact Phone 1 * Emergency Contact Name 2 *
Emergency Contact Phone 2 * Emergency Contact Name 3 *
Emergency Contact Phone 3 * Adults Authorized to Pick Up Student
The Authorized Adults must be listed below. Please note that if your child is going to be picked up by an individual not listed bellow, a parent/guardian must call to authorize the pick-up via phone.
Adults Authorized Name 1 *
Adults Authorized Phone 1 * Adults Authorized Name 2 *
Adults Authorized Phone 2 * Adults Authorized Name 3 *
Adults Authorized Phone 3 *
Adults NOT Authorized to Pick Up Student
Persons LEGALY PROHIBITED from picketing up my student (if applicable). You
MUST provide your ASPIRE Site Coordinator with a copy of the legal document or
court order, or fax it to LEARN at 562-945-0191.
NOT Authorized Person #1 - Name
NOT Authorized Person #1 - Relationship NOT Authorized Person #1 - Reason NOT Authorized Person #2 - Name
NOT Authorized Person #2 - Relationship NOT Authorized Person #2 - Reason CODE OF CONDUCT FOR STUDENT-ATHLETES & PARENTS/GUARDIANS
Please read the Code of Conduct below with your LEARN Student-Athlete.
TRUSTWORTHINESS — Be worthy of trust in all you do.
INTEGRITY — Live up to high ideals of ethics and sportsmanship and always pursue victory with honor. Do what’s right even when it’s unpopular or personally costly.
HONESTY — Live and compete honorably. Don’t lie, cheat, steal or engage in any other dishonest or unsportsmanlike conduct. Plagiarism or cheating is not acceptable.
RELIABILITY —Do what you say you will do. Be on time to practices and games.
LOYALTY — Be loyal to your school and team. Put the team above personal glory.
RESPECT — treat all people, including the coach and your teammates, with respect at all times. Demonstrate an appropriate demeanor that reflects self-control and an unwavering commitment to fair play.
CLASS — Live and play with class. Be a good sport. Be gracious in victory and accept defeat with dignity. Help fallen opponents, compliment extraordinary performance, and show sincere respect in pre- and post-game rituals.
DISRESPECTFUL CONDUCT — Don’t engage in disrespectful conduct of any sort including profanity, obscene gestures, offensive remarks of a sexual nature, trash-talking, taunting, boastful celebrations, or other actions that demean individuals or the sport.
RESPECT FOR OFFICIALS — Treat game officials with respect. Don’t complain about or argue with calls or decisions during or after an athletic event.
IMPORTANCE OF EDUCATION— The primary responsibility of a student-athlete is academic achievement. Be a student first, and commit to earning your diploma and getting the best education you can. Not achieving passing grades will result in your suspension from the team until the deficiency is cured. Parents, commit your child to earning a diploma and getting the best possible education. Be honest with your child about the likelihood of getting an athletic scholarship or playing on a professional level. Reinforce the notion that many universities will not recruit student-athletes who do not have a serious commitment to their education. Be the lead contact for college and university coaches in the recruiting process.
ROLE MODELING— Remember, participation in sports is a privilege, not a right, and that your student athlete and the parent/guardian are expected to represent the school, coach and teammates with honor, on and off the court/field. Consistently exhibit good character and conduct yourself as a positive role model.
SELF-CONTROL— Exercise self-control. Don’t fight or show excessive displays of anger or frustration. Have the strength to overcome the temptation to retaliate.
HEALTHY LIFESTYLE— Safeguard your health. Eat healthy foods and don’t use any illegal or unhealthy substances, including alcohol, tobacco, drugs and some over-the-counter nutritional supplements, as well as of unhealthy techniques to gain, lose or maintain weight.
INTEGRITY OF THE GAME— Protect the integrity of the game. Don’t gamble or associate with or deal with professional gamblers.
SEXUAL CONDUCT— (FOR PARENTS) Sexual or romantic contact of any sort between students and adults involved with interscholastic athletics is improper and strictly forbidden. Report misconduct to the proper authorities.
FAIRNESS AND OPENNESS — Live up to high standards of fair play. Be open-minded, always be willing to listen and learn.
CONCERN FOR OTHERS— Demonstrate concern for others. Never intentionally injure any player or engage in reckless behavior that might cause injury to yourself or others.
TEAMMATES — Help promote the well-being of teammates through positive counseling and encouragement or by reporting any unhealthy or dangerous conduct to coaches.
CARING ENVIRONMENT — Consistently demonstrate concern for student-athletes as individuals and encourage them to look out for one another and think and act as a team.
PLAYING BY THE RULES — Honor the spirit and the letter of rules. Teach your children to avoid temptations to gain competitive advantage through improper gamesmanship techniques that violate the highest traditions of sportsmanship.Know the rules and follow all the game and competition rules. Encourage others to play by the rules, too.
ACKNOWLEDGEMENT OF CODE OF CONDUCT
FOR THE STUDENT: I have read and understand the requirements of this Code of Conduct and acknowledge that I may be disciplined if I violate any of its provisions. Disciplinary actions may include: (1) verbal warning; (2) phone call to parents; (3) suspension from game(s); and/or (4) removal from the team. Actions may be taken, not necessarily in this order, on a case-by-case basis.
FOR THE PARENT: I have read and understand the requirements of this Code of Conduct and acknowledge that I may be disciplined if I violate any of its provisions.
PROGRAM DESCRIPTION & AUTHORIZATION TO PARTICIPATE
My son/daughter listed in section 1 of this form has my permission to participate in LEARN's KidsPlay Sports League under the supervision of the LEARN Coaching Staff. Games will be held during after school hours and transportation to/from game sites will be provided by LEARN. I understand that my son/daughter will receive a KidsPlay uniform and I am required to return this uniform back to his/her coach at the end of the sports season. I agree to pay a $15 replacement fee for an unreturned uniform. I agree to direct my child to cooperate and conform to the Student Athlete Code of Conduct and to the instructions of the LEARN/KidsPlay Coach, staff, and referees. As a parent, I agree to abide by the Parent's Code of Conduct in all matters related to LEARN's KidsPlay Sports Leagues. If I cannot pick-up my child after practices or games, one of the individuals I've authorized below, will pick-up my child on time.
CONSENT TO USE OF VIDOE OR PHOTOGRAPHY
My signature below authorizes the KidsPlay staff to photograph and/or film my child during the program and I
hereby consent to use of these photographs in LEARN’s KidsPlay promotional material. LEARN may photograph me and/or those in my party during the program and I hereby consent to use of these photographs in LEARN promotional material.
RELEASE AND WAIVER OF LIABILITY
I hereby waive all claims against the El Monte City School District and LEARN and its employees arising from injury, accident or illness occurring by reason of participation in LEARN's KidsPlay Sports League. I understand that participating in athletic activities is rigorous and may result in serious injury or in extreme cases, death. I attest to my child's good health and allow for him/her to participate in the KidsPlay Sports League sponsored by LEARN. In case or an emergency, I authorize any licensed physician or hospital to render such medical aid as may by deemed necessary and/or desirable. Any cost/liability incurred for such treatment shall be my sole responsibility.
DIGITAL SIGNATURE OF PARENT OR LEGAL GUARDIAN
After clicking the SUBMIT button below, you will be automatically redirected to a page where you will review the information you entered and electronically sign the completed registration form. After signing, you will be able to save and print a copy of the signed form, in addition to being emailed a PDF copy of the form.