Reign Academy Registration - Spring 2018
Wednesday and/or Friday from 6-7pm for 7 weeks starting April 25th

$85 for one day (please specify W or F) or $165 for both days

Unisys/Burroughs - 41000 Plymouth Rd, Plymouth, MI 48170

Contact Beth Hatsios @ hatsiosreignsoccer@gmail.com

Email address *
Player Name *
Your answer
Player Birthdate *
MM
/
DD
/
YYYY
Past experience
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Phone Number *
Your answer
2nd Parent/Guardian Name
Your answer
2nd Parent/Guardian Email
Your answer
2nd Parent/Guardian Phone Number
Your answer
Which Session are you planning on attending? *
I understand that I will have to pay in full prior to first session *
Required
I plan to pay by: *
Waiver and Release of Liability
In consideration for the minor Player named above being allowed to participate in any way in the City of Plymouth’s/Plymouth Soccer Club’s sports program, related events and activities (the “Soccer Program”), the undersigned acknowledges, appreciates and agrees that:

1. There are inherent risks in playing the sport of soccer that are significant, including the potential for permanent paralysis, injury and death, and while particular rules, equipment, and personal discipline may reduce risk, the risk of serious injury and death does exist; and,
2.AS THE PARENT/GUARDIAN OF THE PLAYER, I KNOWINGLY AND FREELY ALLOW THE PLAYER TO ASSUME ALL INHERENT RISKS OF THE SPORT OF SOCCER AND I ASSUME FULL RESPONSIBILITY FOR THE PLAYER’S PARTICIPATION IN THE SPORT. and
3. I willingly agree that the Player and I will comply with the stated and customary terms and conditions for participation in the Soccer Program. If, however, I observe any unusual significant hazard during Player’s presence or participation, I will remove Player from participation and bringing such to the attention of the nearest official immediately; and
4. I, FOR MYSELF, THE PLAYER AND ON BEHALF OF OUR HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN, HEREBY RELEASE AND HOLD HARMLESS AND WAIVE ALL CLAIMS AGAINST AND AGREE TO DEFEND AND INDEMNIFY THE CITY OF PLYMOUTH/PLYMOUTH SOCCER CLUB, THEIR OFFICERS, OFFICIALS, AGENTS, AND/OR EMPLOYEES, OTHER PARTICIPANTS, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND IF APPLICABLE, OWNERS AND LESSORS OF PREMISES USED TO CONDUCT THE EVENT (RELEASES), WITH RESPECT TO : (A) ANY AND ALL INJURY, DISABILITY OR DEATH TO THE PLAYER THAT RESULTS SOLELY FROM THE INHERENT RISKS ASSOCIATED WITH THE PLAYING OF SOCCER; AND (B) ANY LOSS OR DAMAGE TO OTHER PERSONS OR PROPERTY THAT ARE CAUSED BY PLAYER’S PARTICIPATION IN THE SOCCER PROGRAM.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT.: *
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A copy of your responses will be emailed to the address you provided.
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