Free Agent Information Form

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

4. Free Agent Gender*

   1. Female
   2. Male

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

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

8. Sport of Interest*

   1. Youth Basketball
   2. Youth Volleyball
   3. Youth Fastpitch (Girls, T-Ball through High School)
   4. Youth Baseball (Boys, 6U-8U)
   5. Adult Basketball
   6. Adult Volleyball
   7. Adult Slowpitch

10. Basketball Season of Interest - Check ALL that apply.*

    1. Spring - Late March through Early May
    2. Summer - Late May through Early August.
    3. Fall - September through October
    4. Winter - November through Early March

12. Volleyball Season of Interest - Check ALL that apply.

    1. Spring - Late March through Early May
    2. Summer - June through July
    3. Fall - Late August through October
    4. Winter Session 1 - November through December
    5. Winter Session 2 - January through Early March

14. Fastpitch Season of Interest - Check ALL that apply.

    1. Spring - T-ball through 14U, April through Early July
    2. Summer - High School, Late May through Early July
    3. Fall - August through September

16. Baseball Season of Interest

    1. Spring - April through May
    2. Fall - August through September

18. Free Agent First Name*

19. Free Agent Last Name*

21. Email Address*

22. Phone Number*

24. Parent First Name*

25. Parent Last Name*

27. Parent Email Address*

28. Parent Phone Number*

30. Age*
    -- Select One --56789101112131415161718

31. Birthday*

33. Grade 2019-2020 School Year (Players move up for the summer season)*
    -- Select One --Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12th

34. Level of Play*
    -- Select One --NewBeginnerIntermediateAdvanced

36. School*

37. City*

39. 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

41. Parent Interested in Coaching?*

    1. Head Coach

    1. Assistant Coach

    1. Manager

    1. Not Available

43. How did you hear about us?*

    1. jcprd.com
    2. JCPRD catalog
    3. Email from JCPRD employee
    4. Facebook
    5. Printed advertisement
    6. School District e-flyer
    7. Twitter
    8. USPS postcard mailer

45. 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.
47. Electronic Signature

Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field