EA Boys ID Clinic - May 10, 2024 at Coal Mountain Park (Cumming, GA)

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Coal Mountain Park - 3560 Settingdown Rd. Cumming, GA 30028
U13 (2012), U14 (2011), U15 (2010) - 6:00-7:30 PM

U16 (2009), U17 (2008), U19 (2006/07) - 7:45-9:15 PM

Dress Code: Wear Red Shirts, Black Shorts and Black Socks.

Note: Bring water, wear shinguards, and parents must be on bleachers side of field.

Player's First Name *

Player's Last Name *

Player's Year of Birth *

Player's Primary Position *

Current Club (2023-2024) *

Current Level of Play (2023-2024) *

Comments for Coaches *

Parent's Full Name *

Parent's Phone Number *

Best Contact Email Address *

Release and Waiver of Liability *

IN CONSIDERATION of being permitted to participate in any way in a Futbol Club Sudamerica (FC Sudamerica) activity (''Activity'') I, for myself, for personal representatives, assigns, heirs, and next of kin: 1. I ACKNOWLEDGE, agree, and represent that I understand the nature of the Activities I have registered for and that I/my player is qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. I FULLY UNDERSTAND THAT: (a) FC SUDAMERICA ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY (''RISKS''); (b) these Risks and Dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE ''RELEASEES'' NAMED BELOW; (c) there may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity. 3. I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE FC SUDAMERICA, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place, (each considered one of the ''RELEASEES'' herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY 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 I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim. 4. I hereby give approval for the participation of my child in any and all USYS, GSSA, US Club Soccer, and affiliated associations or league activities and I assume all risk and hazards incident to such participation, including transportation to and from said activities. I waive, release, absolve, indemnify and agree to hold harmless the USYS, GSSA, US Club Soccer, and affiliated association league, the organizers, supervisors, officers, directors, participants and persons or parents supervising or transporting participants to or from such activities from any claims arising out of injury to my child. 5. In my absence, I hereby give my consent for emergency medical treatment for my child as approved by his/her coach, team manager or another adult escort. I understand that this is to prevent undue delay and ensure prompt treatment, and that only a licensed physician, dentist or other such licensed technicians or nurses will be engaged for such emergency treatment. I agree to be responsible for any and all fees/charges for any such necessary emergency treatment. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY CHECKING THE BOX, 'I Agree' AND HAVE AGREED FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A 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.

Required

Media Release Statement *

Often, during Futbol Club Sudamerica (FC Sudamerica) activities or events, participants will be videotaped, photographed, or interviewed for possible promotions to generate interest in our programs. These images or texts may appear on the FC Sudamerica website and in the local media. Please acknowledge below your agreement to use your child’s photo or text as needed. I understand that release and consent is given herein, and is made without compensation. I release FC Sudamerica, and its staff, from any and all liability, claims, or causes of action with this consent and release. I also waive the right to all negatives, photos, tapes and reproduction, as well as my right to inspect or approve the finished photographs, tapes or interviews. By checking the box, 'I agree', I acknowledge that I have read the publicity release and grant FC Sudamerica the right to use my child's name, picture, video, or interview.

Required

Covid-19 Waiver of Liability *

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. Futbol Club Sudamerica (“the Club”) has put in place preventative measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Club could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing 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 the Club 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 the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, staff, 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 myself (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 the Club or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the 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 the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.

Required

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