Free Agent Sign-up

2. Your information will be shared with teams and coaches looking for players.

4. Who is being entered as a Free Agent?*

   1. An adult (Age 18+)
   2. A child (12th grade and under)

6. Sport of Interest*

   1. Basketball
   2. Volleyball
   3. Softball (Adults - Slowpitch / Youth - Tball through Fastpitch)

7. Free Agent Gender*

   1. Female
   2. Male

9. Free Agent First Name*

10. Free Agent Last Name*

12. Email Address

13. Phone Number

15. Parent First Name

16. Parent Last Name

18. Parent Email Address

19. Parent Phone Number

21. Age
    -- Select One --56789101112131415161718

22. Birthday

24. Grade 2018-2019 School Year
    -- Select One --Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12th

25. Level of Play
    -- Select One --BeginnerIntermediateAdvanced

27. School

28. City

30. Desired Location of Play

    1. Mid America Sports Complex - Shawnee
    2. Heritage Park - Olathe
    3. Okun Fieldhouse - Shawnee
    4. Roeland Park Sports Dome - Roeland Park

32. Parent Interested in Coaching?

    1. Head Coach

    1. Assistant Coach

    1. Manager

    1. Not Available

34. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your form will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you acknowledge that the leagues at Okun Fieldhouse and the Mid America Sports Complex, Mid America West Sports Complex and Heritage Park are designed for team registration however JCPRD does collect data on individual players looking for teams. Coaches/Managers often contact JCPRD in pursuit of players to fill rosters or to promote a tryout. Your information will be placed on a list of eligible recruits and you will be contacted directly by a coach/manager if selected for a team or tryout. Coaches are not affiliated with JCPRD. Any coach/manager who may contact you is not a representative of JCPRD, has no affiliation with our organization, has not provided us with personal information and has not received a background check. We stress the importance of scrutiny if approached with options for play to guarantee a good fit for each person and family.

    1. I agree.
36. Electronic Signature

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

* indicates a required field