2017 Annual Registration – Payment 3
06/06/2017
Uniform Order
07/05/2017

2017 Annual Registration – Payment 4

$0.00

Notes:

If your child is in the 2011 age group, only 3 payments of $550 are required, rather than 4.

If your child's position is 'Goalkeeper', there are only 2 payments required, rather than 4.

Name *

Team (Birth Year) *

Position *

Parent’s Name *

Address *

Payment *

Agreement *

I understand that i am signing up for an annual program, I have
taken the quarterly payment option of $550 or $585 per
quarter. Payments are due on or by June 10th 2017, September 1st 2017,
December 1st 2017 and March 1st 2018. I accept all charges and am fully aware that i am responsible for the payments on time or will incur a 5% surcharge on all payments more than 14 days late. All payments are non refundable, you may receive credit for any time spent injured or unavailable with appropriate evidence. I give permission to
Valencia CF Academy to use my card details and to set up a payment plan in accordance with the above schedule ONLY.

Waiver *

Waiver

I, the undersigned, in consideration for my voluntary participation in organized soccer, do hereby willfully acknowledge that my signature below attests to my understanding and agreement that:

My player status will be kept in good standing. I will not compromise myself in such a way as to do harm to the league or tournament, knowing that players may be dismissed from participation, with possible loss of payment or dues, for violent conduct or unsportsmanlike behavior on or off the field of play. I agree to pay for any and all damages to any property or indemnities caused by me willfully, negligently, or otherwise.

Soccer is a physical, contact, sport that involves the risk of injury. I assume all risks and hazards associated with my participation in the sport. I am in proper physical condition to participate in soccer practices and games and have no illness, disease or existing injury or physical defect that would be aggravated by my participation.

I will inform my coach if this status changes. I further acknowledge that this risk may involve loss or damage to me or my property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care. I have a current medical consent form in force. I will wear shinguards, properly-fitted and appropriate shoes, and other protective equipment (e.g., mouth-pieces), as provided by soccer rules, to all events.

Valencia CF Academy NY does have personal injury insurance that covers my participation. However, I should have a current, active, personal injury insurance policy in force, which covers my participation. Under any condition, I am responsible for any and all medical expenses arising from my participation, both in practices and games and while travelling to and from these events. I have the right and responsibility to inspect the equipment and facilities prior to events and, if I believe that anything may be unsafe, I will advise the coach or supervisor of the condition and may refuse to participate. Participation assumes consent.

I understand that I am responsible for all annual dues once the contract is signed, if I take advantage of the payment plan – I will pay all installments on time, any late payment accrues a 5% interest charge.

I authorize my photograph, picture or likeness, and voice to appear in any documentary, promotion (including advertising), television, video, or radio coverage of the league or tournament, without compensation. Players will not enter into any negotiations with scouts or agents without a Valencia CF Academy representative present or without prior written permission.

I authorize that an unaltered copy of this form may be generated and given to the officers or directors of other leagues or tournaments in order to allow my participation in their soccer programs, if the form is required and I have requested to participate.

I hereby release, waive liability, discharge, hold harmless, indemnify, and covenant not to sue, Valencia CF Academy NY, Valencia CF or LIU; CW Post and their associated directors, administrators, officers, managers, employees, coaches, trainers, volunteers, sponsors and advertisers, and other agents, estates or executors, from any and all liability incurred in the conduct of, and my participation in, their soccer programs. This includes owners, lessors, and lessees of premises, municipalities, government agencies, successors, heirs, and assigns.

I have completely read this document and fully understand its contents. I acknowledge that I have given up substantial rights by accepting this document and that I do so voluntarily. My signature attests to this on behalf of myself and my executors, personal representatives, administrators, heirs, next-of-kin, successors, and assigns.

As the parent and natural guardian or legal guardian of the participant, I hereby agree to the foregoing Waiver of Liability and Release for, and on behalf of, the participant (player/minor) named above. I hereby bind myself, the minor, and all other assigns to the terms of the Waiver of Liability and Release. I represent and certify that I have the legal capacity and the authority to act for, and on behalf of, the minor in the execution of this Waiver of Liability and Release.

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