OLV Soccer Registration Travel
Under 10, Under 12, and Under 14 Age Groups
Age as of July 31st 2018 for U-10 and U-12.
Under-14 age is as of Jan 1st 2018
Email address *
Player's First Name *
Your answer
Player's Last Name *
Your answer
Sex *
Required
Date of Birth (Month, Day, Year)
Month of Birth *
Day of Birth *
Your answer
Year of Birth *
Your answer
Soccer Program Assignment
(Based on Player's age as of July 31st) (U-14 is Based age as of Jan 1st)
Age Level *
available Age Levels (Under 10, Under 12, Under 14)
Required
Assignment Information
Information that could be useful in placing on team
Your answer
Contact Information
2nd Email Address
Optional
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
Primary Phone *
Your answer
School Player will Attend in Fall *
Your answer
Grade *
Your answer
Emergency Contact Information
During Games and Practices
1-Contact Name *
Your answer
1-Relationship *
Your answer
1-Phone *
Your answer
2-Contact Name
Your answer
2-Relationship
Your answer
2-Phone
Your answer
Does your child have any medical conditions the coach should be aware of? *
Please Explain if Yes.
Required
Health Conditions to be aware of
Your answer
Medical Provider's Name and Policy Number *
My/Our child is covered by the following Medical Insurance.
Your answer
Participant Survey
(Check any that apply)
(Check any that apply)
Volunteer Information
Anyone who would like to help out on the field during the soccer season must have been cleared and trained for the protection of youth. The Child protection Coordinator will provide further information for the application process.
We need your help to keep the Soccer program operating smoothly.
Please check any position you can help with
Terms of Soccer Program
In consideration of the wholesome recreation and/or learning experience in which my/our child will participate, I/we as parent(s)/guardian(s) allow my/our child to participate in the OLV Soccer Program and confirm the participant is in good health and able to participate in the activity.
I/We fully accept and acknowledge the activities may in involve risk, and I hereby assume the risk and responsibility for all dangers and risks associated with the participant in the activity. It is thus agreed that I/we will hold the individuals, parish, school and field sites harmless from all liability and legal proceedings arising from any injuries connected with games, practices and/or transportation to and from same.
In case of injury or emergency, I for myself and/or participant (if participant is minor/child), and my personal representatives, give permission for an activity representative to call 911 and transport participant to a hospital.. Further, I/we hereby inform by pertinent medical personnel that there are no medical conditions that OLV Soccer should be aware of other than that which is included in this form.
I/We have read, fully understand, and hereby freely sign, approve of, and agree to the terms of the OLV Soccer program. I/We hereby unconditionally release, discharge, waive my rights and remedies, and agree to hold harmless the activity representatives from any and all claims, costs, losses, damages, or expenses associated with, in whole or in part, participant’s involvement with the activity.
I/We certify all answers and information provided on this registration form are to the best of my knowledge true and correct.
I/we have read and agree to the terms of the Our Lady of Victory Soccer Program.  *
Required
PARENT/GUARDIAN AUTHORIZATION *
Parental Digital Signature
Your answer
Media Release
I/we hereby consent that any photograph or video or any reproduction thereof either whole or in part taken of the stated participant by the staff or volunteers of the Our Lady of Victory Soccer program may be used for advertising or informational purposes including non‐broadcasting, web‐based and/or demonstrational use. *
Required
Parent/Athlete Concussion Information
Below you find the definition of a concussion and common signs and symptoms:
Definition: A Concussion is the most common type of brain injury. It is the result of a direct blow to the head or body causing the head and brain to move quickly back and forth.
This injury typically results in impaired of neurological function.
The brain ceases to function normally and may result in the signs and symptoms listed below.

It is important to understand that the signs and symptoms listed below are common for a concussion, but may exist independently of one another;

Headache, Neck Pain, Nausea, Vomiting, Loss of appetite, Balance Problems/Dizziness, Drowsiness/Fatigue, Difficultly Sleeping, Nervousness/Anxiety, Sensitivity to light/noise, Double Vision, Altered Emotions, Ringing in the ears, Feeling slowed down, Feeling in a “fog”, Difficulty concentrating or remembering, Confusion/Disorientation.

Please go to the CDC concussion web page for more information . www.cdc.gov/headsup

I acknowledge that I have read and understood the information regarding concussions. I acknowledge that I have received information about concussions. I know and understand that I should notify my healthcare provider(s) when I suspect my child may have sustained a concussion. I take full responsibility for notifying if I do think they may have a concussion. *
Required
RULES OF CONDUCT
Players shall:
- Have fun and enjoy the game
- Attend practices, listen and learn
- Treat all teammates, coaches, opponents, parents and referees with respect
- and shall not be critical of referees, players or coaches
- Know and adhere to the rules of the game
- Be a positive support to teammates
- Display self-control at all times and shall not use profanity or approach any player, coach or referee in a threatening manner
- Exhibit good sportsmanship, be gracious in defeat and modest in victory;
- shall always shake hands properly with the opposing players at the conclusion of each game
- Remain with their team during the entire game

Parents/Spectators shall:
- Be respectful of the emotional and physical well-being and development of all youth participants
- Allow the coach to coach the game and refrain from directing players on the field
- Maintain a positive sideline demeanor and provide encouragement to all of the players
- Control emotions and provide only positive comments to players, referees, parents and coaches of either team
- Concerns shall not be addressed to players, parents or referees of either team at anytime.
- Concerns shall only be addressed to the OLV coach either by e-mail or by phone.
- Any person that is not conducting themselves in the proper manner may be asked to leave the field
- Please communicate these codes to others attending your child’s games

Rules of Conduct Acknowledgement *
Required
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