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  • Indoor Goalie Training Program
    Fee: $100.00
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    Registration and Payment
    Important: It appears that you are accessing this form from an unofficial third-party source. Submissions originating from such sources will not be accepted. Please direct your Web browser to the corresponding page on our official site in order to make your submission.
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    RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

    THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS; PLEASE READ THE ENTIRE DOCUMENT BEFORE SIGNING

    I, the above named individual, being a least eighteen (18) years of age, or being the legal guardian of the above named individual who is under eighteen (18) years of age, inconsideration for the use of the facilities, services, equipment, programs, and or activities provided by Element Athletics, its owners, partners, successors, assigns, employees, and/or agents (hereinafter the Releasees), do hereby agree, acknowledge, promise, and covenant on behalf of myself, my heirs, assigns, estate, personal representatives, or the like, as follows:

    POLICIES: I UNDERSTAND AND ACKNOWLEDGE that Element Athletics hereby reserves the right to dismiss or prohibit any participant from the premises for disciplinary reasons. Such reasons may include, but are not limited to: unsportsmanlike conduct; possession or consumption of drugs or alcohol on the premises; violence; posing a danger to others; any illegal activity; or violation of any rules whether stated or implied. Such dismissal or prohibition shall be at the sole discretion of the Releasees and failure to dismiss or prohibit and individual for any above reason in no way constitutes a waiver of such authority or discretion. Should a participant be dismissed or prohibited NO REFUND will be given.
    ACKNOWLEDGEMENT OF RISKS: I hereby understand and expressly acknowledge that participation in the events and activities and the use of the equipment and or facilities offered by the Releasees bear certain known and unknown risks which may result in INJURY, DEATH, ILLNESS OR DISEASE, PHYSICAL HARM, MENTAL HARM, OR OTHER DAMAGE to me, or the minor identified above, and/or my personal property. I DO HEREBY UNDERSTAND, ACKNOWLEDGE, AND ACCEPT that such risks may also result in claims against the Releasees and/or claims against me, or the minor identified above, by spectators or other third parties.

    I DO HEREBY VOLUNTARILY AGREE AND PROMISE TO ACCEPT AND ASSUME ALL RESPONSIBILITIES AND RISK FOR INJURY, DEATH, ILLNESS, DISEASE, PHYSICAL HARM, MENTAL HARM, OR OTHER DAMAGES to myself, the minor child identified above, and/or my personal property arising from, directly or indirectly, the use of the premises, facilities, equipment, activities, and/or services provided by the Releasees. I understand that the risks associated with sports include, but are not limited to, sprains, cuts, contusions, abrasions, concussions, broken bones, bone fractures, and in some extreme cases long term scaring and/or death and hereby state that the undersigned is participating at his or her own risk with full knowledge of the dangers and risks associated with such participation. I further acknowledge that Element Athletics strongly recommends the use of any and all NCAA approved protective equipment and that failure to use such equipment may increase the probability of the above mentioned risks.
    RELEASE: I, FOR MYSELF AND/OR THE MINOR IDENTIFIED ABOVE, DO HEREBY EXPRESSLY AND VOLUNTARILY AGREE AND COVENANT NOT TO SUE THE RELEASEES AND RELEASE AND FOREVER DISCHARGE the Releasees, their agents, employees, affiliates, sponsors, or partners, from any and all claims, liability, actions, demands, causes of action, or damages which are related to, arise from, or are in any way associated with my use of the facilities, premises, equipment, activities, and/or services provided by the Releasees, INCLUDING, BUT NOT LIMITED TO, ANY AND ALL NEGLIGENCE OR FAULT OF THE RELEASEES, THEIR EMPLOYEES, AGENTS, OR AFFILIATES.

    I FURTHER PROMISE AND AGREE ON BEHALF OF MYSELF AND THE MINOR CHILD IDENTIFIED ABOVE, TO INDEMNIFY THE RELEASEES AND HOLD THEM HARMLESS from all costs, including but not limited to, defense costs, attorney’s fees, medical bills, pain and suffering, damages, or the like, incurred in connection with claims for bodily injury, wrongful death, or property damage brought by me, my estate, guardian, or other party on my behalf.

    I hereby state that I am in the best position to determine by physical abilities and limitations, or those of the undersigned minor identified above. I expressly acknowledge that I, or the undersigned minor, are in good physical and mental health and have no condition, disease, disability, or impediment which could impact my participation in the activity or which may increase the risk of harm or death to myself or others.
    LICENSE: I hereby grant Element Athletics an irrevocable, royalty free, worldwide license to use my name, image, or likeness for advertising purposes including, but not limited to, photographs, brochures, videos, electronic media, promotions, publications, or any other trade or advertising materials published in and medium.

    I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT BY SIGNING THIS AGREEMENT I HAVE GIVEN UP CERTAIN LEGAL RIGHT AND HAVE DONE SO FREELY WITHOUT COERCION AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE FULLEST EXTENT PERMITTED BY LAW. I AGREE THAT SHOULD ANY PART OF THIS AGREEMENT BE HELD TO BE INVALID, THE REMAINING PORTIONS SHALL REMAIN IN FULL EFFECT

    Element Athletics Player Registration Cancelation and Payment Policy
    1. Payments are due on or before applicable due dates (refer to pricing sheet for programspecific payment details).
    2. Late payments are subject to a $15 late fee.

    2019-2020 Element Athletics Program Specific Pricing
    1. Travel Indoor Team
    a. Tryout fee of $45 due before or day of tryout
    b. Season Fee $650
    I. $200 due Nov 16, 2019, plus $85 uniform fee (if player doesn’t have one)
    II. $200 due Dec 15, 2019
    III. $250 due Jan 15, 2020

    2. Turf Travel Team
    a. Season Fee TBD
    I. 50% of total fee due before or on day of first (1st) practice – early April 2020
    II. Remaining 50% due May 15, 2019

    Element Athletics Player Registration Cancelation and Payment Policy
    1. Payments are due on or before applicable due dates (refer to pricing sheet for programspecific payment details)
    2. Indoor Travel Program
    a. Cancelation notice (written) received prior to Dec 1, 2019 - amount due prior tocancelation notice being received is non-refundable and responsibility of theclient.
    b. Cancelations after December 1, 2019 – client is responsible for full season fee.
    c. All amounts due prior to cancelation notice being received are non-refundableand responsibility of the client.
    d. Any player not current with payments forfeits right to participate in practices.
    3. Turf Travel Program
    a. Cancelation notice (written) received prior April 15th - amount due prior tocancelation notice being received is non-refundable and responsibility of theclient.
    b. Cancelations after April 15th - client is responsible for full program fee. There areno refunds.
    4. Client Late payments (payments received after applicable due date) are subject to a $15late fee.
    5. Alternative payment arrangements are available by contacting and if authorized byElement Athletics.

    Element Athletics Player / Team Tournament Registration-Cancelation Policy
    1. Local Tournaments
    a. Full payment must be received a minimum of 2 weeks prior to the event.
    Without full payment a player/team (client) is not considered registered.
    b. Full refund with 2 weeks’ (14 days) or more notice of cancelation prior event.
    Cancelations with less than 2 weeks’ notice, the client is still responsible for fullpayment.
    c. No refunds with less than 2 weeks’ notice of cancellation prior to event.

    As of August 1, 2019
    d. No refunds for no shows, forfeits, lack of players or any other reason with theexception of possibly weather (see below).
    e. If client no shows, forfeits, lacks sufficient number of players, or for any otherreason does not participate in the event, the client is still responsible forpayment.
    2. National / Regional Tournaments (e.g., RCC, Beach Bash, 4Goals, Shooting Stars)
    a. Player cancelations (written) received after initial payment due date and prior tofinal payment due date– initial amount is non refundable and responsibility ofplayer.
    b. Player cancelations after final payment due date – player is responsible for fullpayment amount.
    3. Player Late payments (payments received after applicable due date) are subject to a $15late fee.
    4. Team Late payments (payment received after applicable due date) are subject to a $50late fee.

    SafeSport Policy and Practice InformationSport should be a place where young people can develop, learn athletic and life skills, becreative, make mistakes and have fun – and do so in a safe place. As members of USA FieldHockey, Element Athletics and its coaches support and adhere to US Field Hockey SafeSportpolicies and practices. For more information please visit the US Field Hockey website.
     
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    06b9P58e0afc6b2465be2aal3eas4e 3c0lear 7tf5h5fi0997s5 30bfc0iel6ad a10b1e-5e1>739844154236 * REQUIRED
    d03P988lacea560aafb7s79de5e cdl3d0e0ar 3t51hfd5i6s 8bf6cf10e907270ie42d08l5deee 57cd7b->33 * REQUIRED
    ff2d8Pf49lbefas96e5 44fa2caacbl0ea3rc5 2162df8c22thei40b0s39 bf7ae10fie4l5edb59 94f35-d7>4 * REQUIRED
    8P717ledbe1790bd9as9144a495e ecl03eff6ar c30t5d65h8774ib4s 20c6854aabfe9df4ield0 5->1ae2b2 * REQUIRED
    ePflff0ece7aa4cse2 a2cb3a6dclc0211fe2aer541 th9isbd e189fi4a230077faa5e8705l26dfd9c 2a-2>4 * REQUIRED
    c191bb7Pbl6c9bea4e9bse 36cca2l7aea1cd265rea08c8f3 3f201te3b7h8fi4as 0976field11ae 8b9-0>2d * REQUIRED
    cf57e9dPaa21ba9l3f10b0dcefa25s8e 6cl5e0c892152ar6 01te4918hcis59f0 2fa0i5el782d f2bc9-b>a0 * REQUIRED
    64dc4488P38d4lea2aes43fe8 cfbbl0eac3490r9 0ea34791at2a3hi0s15f3 cf4f63fi1176c01el0d8f ->ef * REQUIRED
    P57dl56d2e41aa61s5e66d dce574l3aedf0bb966a634dr6b4 th331is5179 0f649a8ielbb527d4a -0b9cd>1 * REQUIRED
    c93b9e25d0P8lea9sebe2 9fa47cleca0443e9r9 t023fb9hifdbe2cse3b2 fie9ldc5d7f239 3-b4342>89da2 * REQUIRED
    e27bbPfl370b485e2505a68s114ec125d c43le82a9db1r970 fa8tch648i5s 14cd1a171ad0ff6iel9d ->2c6 * REQUIRED
    cf498e43Pc2ldeebaas0e 1535c7le2a7rb23920 2104thcf39732a005ei1sb94 3fi5da274eld3 91-24>fe79 * REQUIRED
    8791dPcl2e7fa77sced0eaab797c6 c5d3fl11e6a4er37c25a7 t8h8i0s67b6ea9 fee82f9ia22e5lb9d9a ->2 * REQUIRED
    4f3f1P43lfcea9see c3016c4l52e4fabr a27t1c59d5h0f019i2s 6a9bac8df2c2icelc8dd d03-ec55>9a893 * REQUIRED
    eP0c15e5l8f120ebaa7dc3651s35e3 89586c6leb90781a38r th41i643a2160sd fibe452b78l1b0d4ed9 b-> * REQUIRED
    519a63bP9e5d357dle114absccee68 f725dce8le6dar c4fe40thi2sd 4acfd1ieladf990 -12c3>bbb1abb0d * REQUIRED
    dfb14440Pl16e17a0f0se a9cc22c1l69e9ar015 6td623838hi8877s fdi5213elcd5 b610c40c5fafb0-e>53 * REQUIRED
    5766b6c1fPleab9s79e1 cd3ca77l4ea9ra t690hi54s3e7b9abe5 f19c3fdeacief14d1cbl341d7a -f>736ef * REQUIRED
    7eabP03f4282ab2clce1a54s3edd c34leabare2a6 df4dea7t58d7chis f4die22a2086del9d e-55be598>c6 * REQUIRED
    65P0bdd1572916661fb94l0de69c8ase52b 7e60cale07e2ba65fb4r41 t473ha3215d8i8sc 04bf7ield -4>c * REQUIRED
    P6l3db0e078as4bde5e34f cl8de08ar8ea e6f172t1h30f60e4bc071i1fs 026fie05eee6576ald40e4 ->ee3 * REQUIRED
    2bP68l22104de12eca7141das982e 49c3le684fa9r 850336thie12s66060 7ffice83ld4967a -d83fd>98c1 * REQUIRED
    f3e4Pl675efeba5sae9511 2cf5le9fd8445ea30r6 57et64hb98bi6s3 be6c85fied7a1lebd8 8ec883444->b * REQUIRED
    5c96Pelbe1e23adsaa7ed cl2cbeae56ar06 9ta0ha71fb40i59dd90sfc 31ddf04id0124eld 9d94f-3f30>2c * REQUIRED
    f3e1bcd9Pb898laeads32efb c2l0f73eb7arb1754 ftcfahi533f209esb57 9ffi08738el79d339a 5-ef3ca> * REQUIRED
    aP24a32l2ec8asea5 cb80afc3lea65rde 3be9t5a1he00ab0i64s828045bd8 fielc283b4d 00-4ec4a>c2c1e * REQUIRED
    77Pelb50f8deabas95ea0f fdcle78e18baa5r etd2cfh34ic566s2f37 fiea2lc1f3f3dbff0c -a5>86520050 * REQUIRED
    46a69P68a76leda02a4aseb7 8c838l5a100ee2293adrd6448385 t0hi1s33 687816f1ieelbcdd357d336 ->4 * REQUIRED
    e36dd6cPl32e931dasea3715 94c2deed1c42el00e99a6b1ar2 d58tb335hif6s6d46e3 fc9fb1i9elbdc 7->2 * REQUIRED
    b0Pl7b2ee2a6s0801cbbeb68314a dcelc3bfe73410a222aa2r0 0t09d4h0ies7 f6i5el2da 7201e-ab>23a1d * REQUIRED
    2670094Pel67f52881566e3aea2s6e 22c7281ecaaldc6be1ar9e746e td517his418 bffbaielfc786d5 16-> * REQUIRED
    0c6P637leease37aac 401c12dc9ld0ea7be2r d20et822haaibf2fs6 5f8i42f6e8ce9ld4d -08722b9>c1f4a * REQUIRED
    a7b4Plea3a39dcs99fa21be1 55afb75cbcleabcr003 btc9af5bh8d0e26i2s2 c5dffa564ie3ld47 a->9d5fd * REQUIRED
    7Pbbflb7e96a0e570e85sfee 93ac4calea767r5bb 9a932t0fhed1i21s c8fc06ie0lfcd6 d-6e>cef5196cad * REQUIRED
    ebc700dd0f5Plea8se 7cc925l6ea7rc 60td08dahi8254basdc e95fa23ie0c4a41cee0cc1al33d3d4d ->185 * REQUIRED
    4d7P1le37a05s1c8e92 4c3c5lc3e1daarbfb12d25c6 633c9thbies61 7f1ie5ld13ed7d f721-8af8>595390 * REQUIRED
    7P5a8l3e68a5sdeb13f31a0 acle08283a89dr5f 4fb4dace40t8hisfe c590f9f5202i204f9el5df3 -0a6>22 * REQUIRED
    f0fdP064ledef932ase2 9c7d1db24f6ade3dcc3ala69ac3f5e4a9frf th6i99s3a97 60b299f3fi4ele0d ->d * REQUIRED
    5Ple13a51d9as8eef5 ec2fcfl2e895aa00r0 3c659teb3hi42cs704cf20b5 bcc7fdfd9eield0 f3-09871e8> * REQUIRED
    325cc5dP33dl6184ecas2e 8cl6e6arb 07c3tdh3aaf4ci6s fb87e3i4e8541ldd 4be702-1>62545f94218d0b * REQUIRED
    b91f0674e780acP79ec9lec585dc6eabfs7e clbeaa28f49d9ra8 602f3thei0asdb fiefflfd6fe8c1 ->731b * REQUIRED
    c7de02f77afd60cP875fl90eas7d1e cl123fea991e9r4cce t8hi42sc7f ffifefld -63860a2>b80b2806784 * REQUIRED
    5eafP0c8al4fe62ae2a69995s7394a4be7 dc10214el89fd0e8cafr th4i3s10d2c 0dc71ffeeia3eldd ->6fa * REQUIRED
    a159648Pb50e9fl1ead7s2370eea 06cle98a8rb 4at0dc330hbi7s 72field39 ca575c3076-1a7f709b2>8e7 * REQUIRED
    Pa20f55198lf021af7eafs39e22d cl02d17fd0d52aeea4r t06dhdfics da7e356d9f68if0ecld 4fbd-28>17 * REQUIRED
    8Pe6a846l952a6ed88asae6 9dacled7ece196610a441bad0brf ce1thi1s93 fie1l0dca2 d01a97cb->d8a83 * REQUIRED
    a2de0f6401f0Pdl83e3easedab0 c3bb2lef1a3fr86e 196thea9c926ecbf306i5s 6f1fieclc3ed 08633-6>1 * REQUIRED
    adbP029leas3b20e 4c4911le763a5678e0bb8eac62d57er9 d5thbi943s cf4i8eeaf7ld80e6 0e->d29e1ce0 * REQUIRED
    253eff5P4b7ble6fe2a4sab0ed5c cle58e965ar8 t4h60a3c39i571223b2s 9fei52elc0daadb 1-18ac497>8 * REQUIRED
    3cc43f3e4811b68cP6eeleedfe2afsae72 cle87a538ar t27h764fi948s fiel13a23897f3da a83d->739730 * REQUIRED
    f3193Pl16bffd3easce 9c8ble753a79r2b84c8b5d7 dcth4239is1c8 736686f01884i913el6547dfb 5->f93 * REQUIRED
    3efa8778bPle45ef3daa4sc79ec1d 7ac3lff0c518dear ft2ha2is 75f3fa39a62cibeb352l3df9cdd -eee>e * REQUIRED
    P8l4easea8 fc64f021a32acal9d5eaadea7cr6 d1t2his77723 583afid52e5dl2edb5dd149a5 -2>36697236 * REQUIRED
    Plede5a803b0s8e42ec ecfc70a85eleb5adaar 9e113thc70is f0b7ecia0b81e112c2ld34 0c42b-1>ac4381 * REQUIRED
    3c9Pale4ad8339c25ds91ee25 9c3ab9b10lee30d9aa1dr6 6648d5th310is01b70a f1ic6eed67beld 2be->a * REQUIRED
    356a14Pl69410f11ea1c4se9b 9c0l3e1afr4259d85 6883t2838ha37ias0f22 9f81fiee2f4l9d2f3 6-4e>42 * REQUIRED
    bPblaea4ae09737sbe58eca3 c6677el7ce7cadaa632ra tbhid0s 5f2a2069i6e90d95l5373dda c9-2a1>a90 * REQUIRED
    1Pl6e8a9cs8586e 44a9ccdc80le0aea7rf7c t6hais422565c95fa78 f6a8i265c3c1e412el2d7e7 1a0-f>53 * REQUIRED
    06bPle5e83as36eea cdclfe3a81r f82t8739ffh1i90e65s30 b7dfi38de65c381543lf8a62d0ede 9dd1->d4 * REQUIRED
    c4f7Pb99l2d9de4as0ea 454c2c9aff3l4e5ar t0hi4f0612s29 fi9a9efcl82ad79 -168ef00509886c4f682> * REQUIRED
    692222P16l7ebeeasa7dabe 3ccfl5745ee9ar69b 77et29ch42ics f7feielf500506ebd814 ->9edb1a5548c * REQUIRED
    4Palea5986a3b408696s8a12e1 565f2cle0abcar bt8ba1f8hifbs 3fiadade591394cd7l7d -d>0e38f495af * REQUIRED
    a2bdbPlae1a73s938e cl4e1fb27efea03r t54h73ib8b407135bs41a211a09c6 5fbcielcd dae-81d6>e7637 * REQUIRED
    82b5Pa707e56260161l7b0e18a3a69s06e0 90cl4b95e63arf ctdhiefdsac34 fi4ec275ldf8d -948b>b4b3a * REQUIRED
    6P4a0ebl98c20be974as0bb2c01e9342 clded63ar18 at7h20i3s6c7 fa0f0i7edd59ldc 0-2>5e0d55625fc6 * REQUIRED
    afb231P27al9ea2se c71ba7lebd1e1ar8a9d7e0d6c e8thi53s 19f3fi0bab7a50el0d97e2 e7d-2>5af31cb3 * REQUIRED
    724Pa2lbead12a767854sd8de 366cel0ecada3916dr9ad543 390f7the95648ias7 ea23ef6ia1el3d be-f>c * REQUIRED
    5P3le1f5ac1aseca3ddd36728ad 1cl55e0c0far73b 3c4ata4hai445s b5f376c8i4e380ee6ldd 0e3-b044>0 * REQUIRED
    3Ped12c397leac235994862ascb3b9e 0a4e13clea4r 0thi97s251a e91e482c4abf5546fbield ->8be9df08
    * REQUIRED
    78a88P4d0al9215e38as574fe71 dcdcl2eaa06ar1899 0this8525e cf572ddi0e63485l7d8cf 5a5cf-1315>
    * REQUIRED
    63332fd48384a8P19alease110d5a2 eb06825cleafr53 6t8abah8is3 88d5f9i96641e740eld1 c5-f>10a76
    * REQUIRED
    2Pl64f96e9a4d9see5c89e5541e cfbl6aea06c7e3fc7re13b te1h0eie792se95 4f5ie4e174ald99 4-0>3eb * REQUIRED
    P0cal9e8719fab3s7e40a8bf 9ac84learba9 b63a9ce4t0e0hbi1d166s49 9bf9ibe740l0ddffd 0b-757b>53 * REQUIRED
    53f8P8lbae1as98de 29e8caclab0de6574ae81rc 46fthi6s d5ebf3i47eb3ld854c1b 5353e196aa-35>118b * REQUIRED
    11e03205P299l4eaase7 71ce9lac1eeear97 63t49h6ie347es 4468de1fi2ef96ldf 278fe71-c320>b9e1ff * REQUIRED
    da028Pleas167df2cef5 81c2ld187773be3b95ar fb7c4ct61hi264fa9s8 33bf81i28d9e252228l5de9e -4> * REQUIRED
    caea5P7l1e3ac39ded3sc38e3 e81485cle60ffe6a2aear f9590tf2h21i1s f24i8e3bl3191a4da04 784->31 * REQUIRED
    3e4444P952lb59d8448de348bf59a8se626f8 cb10leeac0dr 6dthibasc ad8e41fibe4458ld37 b1-a326>2e * REQUIRED
    daP4l5eaea0as10e6 1cle8de44c7ar6 de1t1h438d90648beb4328i7d15fs 3dd22fd5i977el3cd90 -38>f68 * REQUIRED
    fcc50a8Pl9378605d69ea7s8e37 c3lde8445adaa85rf1cad135396f0d3e this9 ccfecdiec3225l8d0 3->b4 * REQUIRED
    55P2le2base b66fac335bb5lee4a7d2245ra4 64c38t6bh99baisa 57babc5bfi8c7e91ld 37-a>60f8c36bec * REQUIRED
    dac29c51P9dble9aseace 195e95b1865a6cecal51e27b3c5f242a0rbd t6h7is f6ie0ld32 a->1f75542f41d * REQUIRED
    Important: You 0bm4ay be makding ucse of52 a5utomated 6form-afilling s4of38tware. 4Thi4sa 61tf7bype o4f1 sof5tware ca8n trigfbger ou9r h1aidden3 spa6m4-detection7 system, w16hiche w45i0lla1 4block 49yoe9u frodfmd su9bmittingf t0h6i1s formf.4f Pl5ea8sde seleect Fbfix This97c2fa 7b108d073e184f2f3a76f159a996a9d2ofr3ed7f6dc6795ed5 8055ac88ea4272cccome6ple22tibnfg24 0th5e1a eforfbm 815in5 d3order 830d2t18of 84ca5or4259rebe34998ct bt42heded p37ro8blem1c.f0bd49c
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