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Check activities you are registering for: Age Control Date: April 1, 2016 U6 Girls Soccer – (Age 4 – 5) * $65 Core Performance Development Junior Core (Age 7 – 10) $75 U6 Boys Soccer – (Age 4 – 5) * $65 Core Performance Development Senior Core (Age 11 – 14) $125 U8 Girls Soccer – (Age 6 – 7) $75 Intramural High School Soccer League * $75 U8 Boys Soccer – (Age 6 – $75 U10 Girls Soccer – (Age 8 – 9) $75 U10 Boys Soccer – (Age 8 – $75 U12 Girls Soccer – (Age 10 – 11) $75 U12 Boys Soccer – (Age 10 – 11) $75 U15 Girls Soccer – (Age 12 – 14) $75 U15 Boys Soccer – (Age 12 – 14) $75 Please Print Clearly Participant’s Name Parent E-mail Address Address City State Zip Home Phone Work Phone Mother’s Name Cell Phone Father’s Name Cell Phone Emergency Contact Phone Date of Birth / / Age Sex Grade School Medical Conditions/Allergies Current Medications Sibling Name (If in the same league) Shirt Size – Circle one: Youth: X-Small Small Medium Large Adult: Small Medium Large X-Large XX-Large Would a parent like to be a COACH? Head Coach Assistant Coach No How many seasons has your child played? 0 1 or more 3 or more 5 or more 7 or more PAYS (Parents Association of Youth Sports): I have completed the required PAYS (Parents Association of Youth Sports) training. Yes No If yes, the PAYS membership is listed under the following name (Print Name): If no, I understand that I must complete the PAYS program for my child to participate. By signing below, I agree to complete the PAYS program and follow the PAYS Parents’ Code of Ethics. Refund Policy: No refunds or credits will be granted unless requested at least 5 days (Monday - Friday 9a.m. - 6 p.m.) before the session, program draft or league begins. If request is made 5 days prior to the start date, you will have two options: Receive an immediate credit for the full amount valid for 12 months or Receive a refund, minus a 25% administration fee. A pro-rated credit may be issued in the event an activity cannot be completed due to a documented medical problem. Registration convenience fees are non-refundable. Concussion Policy: In order to register, parents must initial here to confirm the following: I, the parent/guardian hereby acknowledge receiving concussion information. I accept my responsibility to report my child’s to OCPRD staff, coaches, and health care providers. I understand that my child must not have any concussion before returning to play and must have written permission from a health care provider trained in concussion management before returning to play. Parent/Guardian/Adult Signature Date 2016 Spring – SOCCER Participant Registration Form OVER *U6 GIRLS AND BOYS Only – Select practice day preference: Monday Thursday No preference *U8 BOYS or U10 BOYS Only – Select practice day preference: Monday Tuesday No preference *Intramural Team Name (Write Unattached if no team) ---PAGE BREAK--- PARTICIPANT WAIVER & RELEASE OF LIABILITY MUST BE SIGNED TO PROCESS REGISTRATION In consideration of the named participant being allowed to participate in any way in the Oconee County Parks and Recreation Department programs, related events and activities, I, the parent/ legal guardian, of the named child, or as an adult participant, hereby acknowledges, appreciates, and agrees to the following: 1. The risk of injury or damages to my child and/or myself from the activities involved in the programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. FOR MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and, 3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives, and next of kin, HEREBY INDEMINFY AND HOLD HARMLESS the Oconee County the Board of Commissioners, and all employees or agents of Oconee County, including all individuals who are affiliated with the programs administered by the Parks and Recreation Department of Oconee County (“Releases”), from any and all liabilities incident to my involvement or participation in these programs or transportation to and from activities, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law. 4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE THE other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my and/or my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 5. I hereby grant consent to any and all first aid responders designated by the Oconee County Parks and Recreation Department to provide my child any necessary medical care as a result of any injury/illness. This consent includes First Aid and transportation to/from first aid responders. 6. I further understand that health or accident insurance which would cover my or my child's medical, hospital, or related expenses in the event of injury in this activity is my responsibility. I understand the Parks & Recreation Department of Oconee County strongly recommends that if I do not have sufficient insurance to cover such incidents that I should take the necessary action to obtain it. 7. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my or my child’s readiness for participation and/or in the program itself, I will remove myself or my child from the participation and bring such attention of the nearest official immediately; and, 8. I understand that I am bound to abide by the Oconee County Parks & Recreation Department's Code of Conduct. I further understand that these programs are recreational and that if either parent should exhibit continued unsportsmanlike conduct, the child may be removed from the program. 9. I understand that the department may use participant images or videos, and that such may be published in an outlet used to promote or publicize the program or department. 10. In addition, I understand that it is mandatory for a parent of all competitive youth sports participants to complete the Parents Association for Youth Sports (PAYS) training before their child can participate in a youth sports program. I HAVE READ THIS RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND WAIVER. I FULLY UNDERSTAND ITS TERMS, I UNDERSTAND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Parent/Guardian/Adult Signature Date