Registration
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ANNAPOLIS SELECT FC ID CLINIC REGISTRATION 2024/25
2017/18 COED
2015/16 Girls
2015 Boys
2014 Boys
2013 Girls
2013 Boys
2011/12 Boys
2010 Boys *(High School Age Team Starting in November After High School Season Ends)
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Birth Year:
*
Previous Soccer Club:
*
Position:
*
Interest Level:
*
Shirt/Short Size (CXS - AL):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Birth Year:
*
Previous Soccer Club:
*
Position:
*
Interest Level:
*
Shirt/Short Size (CXS - AL):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Birth Year:
*
Previous Soccer Club:
*
Position:
*
Interest Level:
*
Shirt/Short Size (CXS - AL):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Birth Year:
*
Previous Soccer Club:
*
Position:
*
Interest Level:
*
Shirt/Short Size (CXS - AL):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
10th grade
11th grade
12th grade
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
Adult
college-junior
college-senior
kindergarten
pre-K
preschool
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Primary Doctor:
Student Birth Year:
*
Previous Soccer Club:
*
Position:
*
Interest Level:
*
Shirt/Short Size (CXS - AL):
Additional Information:
COVID-19 Liability Waiver
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The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID 19 is extremely contagious and is believed to spread mainly from person to person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. ANNAPOLIS SELECT FUTBOL CLUB has put in place preventative measures to reduce the spread of COVID 19; however, ANNAPOLIS SELECT FUTBOL CLUB cannot guarantee that you or your child(ren) will not become infected with COVID 19. Further, attending ANNAPOLIS SELECT FUTBOL CLUB events could increase your risk and your child(ren)'s risk of contracting COVID 19. By accepting this agreement, I acknowledge the contagious nature of COVID 19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID 19 by attending ANNAPOLIS SELECT FUTBOL CLUB events and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID 19 at a ANNAPOLIS SELECT FUTBOL CLUB event may result from the actions, omissions, or negligence of myself and others, including , but not limited to, ANNAPOLIS SELECT FUTBOL CLUB employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or my self (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)'s attendance at ANNAPOLIS SELECT FUTBOL CLUB or participation in ANNAPOLIS SELECT FUTBOL CLUB programming ("Claims"). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless ANNAPOLIS SELECT FUTBOL CLUB its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions , damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of ANNAPOLIS SELECT FUTBOL CLUB its employees, agents, and representatives, whether a COVID 19 infection occurs before, during, or after participation in any ANNAPOLIS SELECT FUTBOL CLUB program. I/we have read this assumption of the risk and waiver of liability relating to Coronavirus/ COVID 19, fully understand its terms, understand that I /we have given up substantial rights by agreeing to it and agree to it freely and voluntarily without any inducement.
I've read the above and agree.
Assumption of Risk
(Show-Hide Details)
I fully understand that this Activity involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my child(ren)'s own actions, or inaction's, those of others participating in the event, the conditions in which the event takes place, or the negligence of the "Releases" (ANNAPOLIS SELECT FUTBOL CLUB, its employees, owners & operators); and that there may be other risks either not known to me or readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages my child(ren) incur as a result of their participation in the Activity. I understand that I am assuming all risks inherent in cheer known, or unknown, and am giving up my right to sue. AND I, the minor's parent and/or legal guardian, understand the nature of the above referenced activities and the minor's experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the Releases from all liability, claims, demands, losses, or damages on the minor's account, caused or alleged to have been caused in whole or in part by the negligence of the Releases or otherwise, including negligent rescue operations. I further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim against any of the Releases named above, I will indemnify, save, and hold harmless each of the Releases from any litigation expenses, attorney fees, loss liability, damage, or cost any Release may incur as the result of any such claim.
I've read the above and agree.
Release & Waiver of Liability
(Show-Hide Details)
Students Health: I understand that the athlete should have a medical exam before participating in classes. Both the coach and the administrative staff should be made aware of any special needs your child may have. Failure to disclose any relevant medical information will give up your right to sue, ANNAPOLIS SELECT FUTBOL CLUB In consideration of participating at the ANNAPOLIS SELECT FUTBOL CLUB I represent that I understand the nature of this activity and that my child (ren) is/are qualified in good health, and in proper physical condition to participate in the activity
I've read the above and agree.
Minor Release
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And I, the minor's parent and/or legal guardian, understand the nature of cheer activities and the minor's experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releasees from all liability, claims, demands, losses, or damages on the minor's account caused or alleged to be caused in whole or in part by the negligence of the "releasees" or otherwise, including negligent rescue operations and further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claims against any of the releasees named above, I will indemnify, save, and hold harmless each of the releasees from any litigation expenses, attorney fees, loss liability, damage, or any cost that may occur as a result of any such claim against ANNAPOLIS SELECT FUTBOL CLUB
I've read the above and agree.
Medical Emergencies
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The undersigned gives permission to the ANNAPOLIS SELECT FUTBOL CLUB its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health.
I've read the above and agree.
Refund Policy
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The tuition is non-refundable. Tuition will not be prorated for time off as it is factored into the tuition. If you decide to leave the year round all-star program, you must notify us within 30 business days written notice otherwise you have made the commitment for the entire season. There will be no deductions or credits for missed practice days as athletes are required to attend every practice. We do not offer a refund for the Annual Membership Fee.
I've read the above and agree.
Electronic Signature
(Show-Hide Details)
I have read the, COVID-19 LIABILITY WAIVER, ASSUMPTION OF RISK, RELEASE & WAIVER OF LIABILITY, MINOR RELASE, MEDICAL EMERGENCIES, PAYMENT POLICIES, ANNUAL MEMBERSHIP FEE & DISCOUNTS, REFUND POLICY & ELECTRONIC SIGNATURE, I understand that I have given up substantial rights by signing it freely and without any inducement or assurance of any nature and intend it to be complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. I understand that by checking each box above represents my electronic signature. Furthermore, I have read and understand this ASSUMPTION OF RISK, RELEASE & WAIVER OF LIABILITY, MINOR RELASE, MEDICAL EMERGENCIES, PAYMENT POLICIES, ANNUAL MEMBERSHIP FEE & DISCOUNTS, REFUND POLICY & ELECTRONIC SIGNATURE, I voluntarily affix my name in this agreement.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
Visa
Mastercard
Amex
Discover
Name as it appears on card:
Nickname:
Card Expiration Month:
01
02
03
04
05
06
07
08
09
10
11
12
Exp Year:
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
eCheck/Bank Draft:
Bank Name:
Bank Routing Number:
(9-digit number)
Your Account Name:
(Your name on your bank statement)
Your Account Type:
Checking
Savings
Account Number:
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