Registration for 2024 Bobcats Soccer Academy
Please complete this form to attend summer soccer camp at Nevers Fields in South Windsor. Our camp is fully insured by Loomis and Lapan Insurance. Coach Lepak and Coach Kaufman are AED and CPR certified and will have First Aid Kits at the fields daily.
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Email *
First Name of participant *
Last Name of participant *
Gender *
Camp you plan on attending (check more than one if you'd like to attend more than one camp).   *
Required
Year of Birth *
What soccer team(s) did you child play on in the Fall?  (This is for grouping purposes) *
Shirt Size of Participant *
Each player will get a shirt when they arrive.
Extra Camp Shirts are $10. If you would like another shirt, please indicate that here. 
*
Allergies/Medical Concerns (if none leave blank)
Town you reside in *
Street Address *
Home Phone Number *
Email 1 *
Email 2 (if none write NONE) *
Emergency Contact Name *
Emergency Contact Cell Phone *
Assumption of Risk, Waiver, and Release from Liability  I desire to participate in Bobcats Soccer Camp (hereinafter "the Camp").   This Assumption of Risk, Waiver, and Release from Liability covers the entirety of my participation in the Camp, including any travel.   1. Risk Factors- I understand and acknowledge that the use of equipment and facilities provided by Peter Lepak and participation in the Camp involves risks including, but not limited to the following: risk of property damage, bodily injury, including, but not limited to permanent disability,paralysis, and possibly death.  These risks may result from a variety of circumstances including, but not limited to, the use or misuse of the equipment or facilities, from the activity itself, from the acts of myself or others, including the Camp and its agents or from the unavailability of emergency medical care. 2. Assumption of Risk- I am participating in the Camp at my own free will. I understand that my decision to participate in the Camp is entirely voluntary.  I assume full responsibility for all risks that may arise out of or result from my participation in the Camp, including, but not limited to those risks described in Section 1, above. Excepted from this section are any injuries caused by the gross negligence or willful or wanton misconduct of any officials, officers, employees, agents, or volunteers of the Camp.3. Acknowledgement of Policies and Procedures- I acknowledge that I have read, know, and agree to all of the policies and procedures relating to my participation in the Camp.  I understand that the safe and proper use of all facilities, equipment or participation in the activity is dependent upon carefully following instructions and any policies and procedures. I agree to comply with and abide by all rules, regulations and policies of the Camp, and instruct any dependent participating to also comply and abide by said rules.   4. Release, Indemnify, and Defend.  I hereby release, waive, discharge, and hold harmless Peter Lepak and all of their faculty, employees, agents and representatives, past or present (hereinafter jointly referred to as “the Released Parties") from any and all claims, suits, liabilities, judgments, costs and expenses ("Claims") for any property damage, property loss or theft, personal injury or illness, death or other loss arising from or relating to my participation in the Camp.  I also agree to defend, indemnify and hold harmless the Released Parties from and against any Claims arising from or related to my own acts or omissions in connection with my participation in the Camp.  5. Prerequisite Skills.  I acknowledge that I, or my dependent enrolled, have the requisite skills, qualifications, physical ability and training necessary to properly and safely participate in the Camp.  I agree that if I have any questions as to what skills, qualifications, or training is necessary to properly participate in the Camp, then I shall direct such questions to the appropriate individuals.6. Waiver- I hereby waive any protections afforded by any statute or law in any jurisdiction whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release.  This means, in part, that I am releasing unknown future claims.7. Payment for Damages.  I agree to pay for any and all damages to any property or Release Party caused by me negligently, willfully or otherwise.  8. Representatives.  I enter into this agreement for myself, as well as for my heirs, assigns and legal representatives.9. Consent for Emergency Treatment- I consent to medical treatment for emergencies that occur during or are related to my participation, or my dependent’s participation in the Camp, where I am unable to consent to such treatment.  I understand the provisions of this Assumption of Risk,Waiver, and Release from Liability apply to any treatment that might be provided to me under this Section, including but not limited to Section 1, Section 2, and Section 4.10. Insurance- I understand that I am solely responsible for any medical, health or personal injury costs relating to my participation in the Camp.  I understand that I am strongly encouraged to have a medical physical examination and purchase health insurance prior to any and all participation in the Camp.    11. Severability.  If any term or provision of this Assumption of Risk, Waiver, and Release from Liability is held to be illegal, invalid or unenforceable, or the application thereof to any person or circumstance shall to any extent be illegal, invalid or unenforceable under present or future laws effective during the term hereof or of any provisions hereof which survive termination, then and in any such event, it is the express intention of the parties that the remainder of this Assumption of Risk, Waiver, and Release from Liability, or the application of such term, clause or provision other than to those as to which it is held illegal, invalid or unenforceable, shall not be affected thereby, and each term, clause or provision of this Assumption of Risk, Waiver, and Release from Liability and the application thereof shall be legal, valid and enforceable to the fullest extent permitted by law.13.  Use of photographs.  I hereby grant permission to Peter Lepak to use photographs taken of me or my child(ren) for use in soccer publications such as recruiting brochures, mailers, newsletters, magazines and use these photographs on display boards and to use such photographs in electronic versions of the same publications or on soccer web sites or other electronic form or media, without notifying me. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph. If you do not wish to grant permission for this stated use of photographs, you must inform the Peter Lepak. I have read and fully understand this Assumption of Risk, Waiver, and Release from Liability and understand that it relates to surrendering and releasing valuable legal rights. I do so freely and voluntarily.                                                                                                                Consent and Release on Behalf of Minor by Parent/Legal Guardian                       I am the parent or legal guardian of the above named minor.  I have read and understand this Assumption of Risk, Waiver, and Release from Liability in its entirety and understand that it relates to surrendering valuable legal rights of the minor and myself.  I agree to be bound by all the terms of the Assumption of Risk, Waiver, and Release from Liability.  I also give my consent to the participation in the activity of the minor.                                                  
I agree and fully consent to the waiver above. (Please write your name below) *
Payment  - Please know that your registration is not complete until you pay in full. Please send payment after you submit this form to Bobcats Soccer Academy  *
A copy of your responses will be emailed to the address you provided.
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