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  • Goalie Indoor Travel Program (with Uniform)
    Fee: $290.00
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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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    676Plefasfaa469de39731 cleba654r79e35 t3fah4if395s566a36e f11e914i05e695b0d05ldd 1->124174 * REQUIRED
    71198Plfd7e9e1af4a4se7 f30c00al1e6ca14af3rc8d9 t7fdd3ah6caisf 3fi415feelcd6f60d7 6-793>5fa * REQUIRED
    31Pc6bl7eas71c214e5c017ab97e 4c7b6l6e1a3f9d1r a15tc8a9788409bh4dfi6s 7fiadea6be6ld 8f-d19> * REQUIRED
    fbPf08lad8e09aeb70s3e09 cl958e8b8dar6 af5t3a295heisa 433eff8id2b72eecc2ae80lced2 -c>169bf6 * REQUIRED
    d2851Pl2efd1b517a3sed1ee 2e548bfc1c093l31ea3d1r 9techd2is f4d39ie9a1bld5 66-57d3>979385c56 * REQUIRED
    8Pale2a34090asf98d58e 39cl4ee5a398r22f 2dt1eehddi5scf1df 5e8fefbifdae5f2a0509bldf13b ->b95 * REQUIRED
    P4e5al66e3as6e e2b02661c5l1ea28r8f6a66b464b tf35hi7bds1906e 4fifea0a398ld1961 699-b>56f2df * REQUIRED
    27ebbbdcadfP1leba5esea9538 cb5c3cele4aecc3r 7a8f3thisde1f 7fbaie84fdl8de 47-d4>c9159df53fc * REQUIRED
    5499d836Pa1cc7l70bease 7cc8e63cd2albcee6fdcar2 3a7t4c91hic1s05 fc5ie1lde92020d9a83 a24->a2 * REQUIRED
    b9ee57P0b36flc4c936fe547asee7 81clea5r2 0bt149eha1b6f81i64s41 19c1fi6aa1d0e9lcf5d26da8e -> * REQUIRED
    0Pleasb6d71eaaf1cfa9 c3dl4c0a5c1e8414a649re 3t4h7a89372is 1575fifedfedlad 2fa19-d53b2>cdc3 * REQUIRED
    P3e4f28l66ae9ase 8cdl71e03a65fr b86thdbb9i0es 6fe584ifcec9e65839l0fedfd 9c67d259->c92e80c0 * REQUIRED
    effePle75ab66f76010sae6ed2a15b 0c8l7bbe3a12537363354r thie18s3d 83df1b1ieclecfbd 6-5e>8807 * REQUIRED
    c9dPel7e144a5s0f2823cc5e 852ccc25lfbaeda8r tchi4s3 f2b5bbf654f9iel975d 6ee497->fc6d778260e * REQUIRED
    5Pl037cea3sf20ea 8687dbf73cbl8c8eara6 e107665ce59t5349ahis6 8263fi2eld3daa c-34d>839626262 * REQUIRED
    02P3l301e85ca8e8ds43e c23l7737ed2e60ac2rcc2 49this 071fi934d07e62ald45 ad0ac0ef42->57a6f8b * REQUIRED
    fPlfe1d9as6e5 207228997acc6bl7e0c73aa8aar 7t44h084b56bif3ads2 f05i12e27ld8 f71c4->4b5ed82f * REQUIRED
    c352d5Pcle5a0599b709s2bee 29becle85addr 08th83i990s8e 8d3af76ei1e1lb033d86 5->5b5a8786ae75 * REQUIRED
    45P8l98ef49a86se9e f4d394ecff8l0eab675ar2b ft09a35h6is20 f2af4i3e38dea4ldc8fad -cff5d81e>b * REQUIRED
    f6P5fe6l8e98a37144ds9191e clde37d3119acfr 33th8f160iddsb 42faiee428a28ldbdd0 50-6>f50b2ac8 * REQUIRED
    bbP68a5l31b0e5ca93c5996s4ec bcal84ea5rc056674aa1a40c 969t0hf4ia4935sd 53f7i40e659ldd ->df6 * REQUIRED
    3Pebadle2faecac2efs8e1dde2 3cdclf5ear463d36de th7bi4a01580e4377e1s3e203 8efaie83ld3 -67af> * REQUIRED
    3ce6bdP1ld5e87daasf363e c3l6eada90r e3d8c12et0fhi65da069s6b90 cff2iefbe962lfd 8->5b048ccaa * REQUIRED
    Pl2cfedacfsed72af bcd6clebefa2r3 3f484ft39a1a8chif9s0 755efeiee5lbfd f5-5113855>6d0bf72ffb * REQUIRED
    027e2fPl5901911eefcaec0s0e2c918e3e9df267 cbl2eaa7r the7fi7s12 09f9c27ie1000af2l6737d -9e>5 * REQUIRED
    812933eP2lb17deae7a4sdb2344d1ef765d1 55e06c55l9e3b5a39dbr0 7e3t08hi5ea40f5as5 fieladec ->1 * REQUIRED
    Pl19b9eac1sfe f7ca4l6ear0224768e7a 32tch02cis29575b 703fc9i39delde473 6c-0e0>7b89c0d3227c1 * REQUIRED
    e9182e0117cP0l5ea2s92ee9c4 8c1lad0ea0dr e981528tf037hdi29643sb377 1dfield 9-af2d>5448e08d7 * REQUIRED
    0dc1Ple04ad28a77asee11ae46 7fb9cdle369a7cdr429 t91h78a24ibs cecfi9el56c92533d2c0 86d-3>333 * REQUIRED
    16ac047bfPe5lef63acbb16s1bed8 cd1lae6far99 eth64i7ds f283if215fe7l31d3020cf f-9c90>31e9395 * REQUIRED
    Ple3babs0adfa2e459c0 c6d4el39ear ctf8hia6s 53f7i6bfael8138ab21cd2d8bd 6fc9628-b2b6a3ffd23> * REQUIRED
    fd104c6Pa4b0c8ale0e92a3s4f0de c41cel649b8e11db5a4745r e0f34c71t369fhffis0a f7ieel1ed0c -c> * REQUIRED
    9Pl3ea8se2e cdleabce095r thiaeb0839ed6dc4ebacs5b 00fe58e7a02e3c634ieal4263d 95ac47-b>b823d * REQUIRED
    aPl1eb597a6fc9e26see b6be0e3clc8e827a9r799 4tdeb5h5bcd89iscb26 7fedi2elbe0d 908-1e>d0ecf45 * REQUIRED
    2c4b53P1lea0cc9412bs99bee6d clce30ab53r 63d9thdf5e9ea4i0sc cfi9ele7172328981c4f3d8 70-dc8> * REQUIRED
    0Pf8ld7ea6sec9 7c6l6683ac5a4baee40ar593a510ed th33idef04f2s 415f5i2b31cee08clde 82da52->c2 * REQUIRED
    073P0lde7a72bs16eb1 c8ff1learff1d55 thc158e4ia069c25fs4 4eea94316f0ai2eal556d -b184e>5d8cf * REQUIRED
    30db7P6745elc94e0afbb31a1c5s2b10e f3554cle1ae4r 67777825aec39848t5h8is fiel0d18 34b->ce6d4 * REQUIRED
    4f4015a9Pdl5ec44ascbbe0 ec6f2le464a1af0874ar01d edta10h7i94sdf78 ffei7b2el3d 57553b5c-be0> * REQUIRED
    0e021Pb9la53fcefa6203e20se61 cla4ear td53e1hb506i280f2s6 d9aff4i3eac4l0d9 d4f-1>642a4fd450 * REQUIRED
    fPa7le4aa77558c0seb8bb44ef 60d1eclf58eac37933884r th30i7dsaabc5 c662fi5e65201fac5ld 7-3>6c * REQUIRED
    de3a1Pafd3197el47bef3ase83a66877be6506a 04b6cle8b3a99r e072tdh138383is f9a6i13e88e6ld ->a3 * REQUIRED
    244Pl8e57a0018s4ded2 c30laeacb2r et9fhbfebie1sf f02797c7edcd53af6i4dd8ee7l81f046d0 6->a0d1 * REQUIRED
    5dP2l4eca1e7sbc5f2e d52c161dl69eb5eda13br ec512te449h9ae8e5ias3 08f687ciecl6d2 -9>b764d808 * REQUIRED
    bcPldease9 3be59d05af8e098f4647ffa28cl64e6efa7ar690 6bthi815es6 0dfic2e3el3af8da38 7-b>ac3 * REQUIRED
    5315P11l76568edba7d8as7beb 2cl55e2adc5er 410b4848ct353h44id1da20s 4fdeiebl1dd d-2b8bfbd>c0 * REQUIRED
    fbfe8Pl3ade346098c3a8s2ea 9ccb30bleacrfce 856t6ha4b275i3s7dcc 0fbif63e358a0lad 47500->14c3 * REQUIRED
    d208a463bP5l49be52as5ebeaf58 cle2baare05 fth1b08b12i50s7c fc51icecl5d 005b-a5864>11c41b1f8 * REQUIRED
    40P50l2e4aba4se6 fda719c4l292836e1d20dar77c t45fcbh3is7405 b9fidb76c8ab3be0cbledeaddca ->1 * REQUIRED
    e9e9dP5lb2ea1cse93 3cle4efa73c671551rec 0th019i4c2sd 8ad2f004i26eebee920l3d3df83 -2>7d7261 * REQUIRED
    c3P3l7f64ea767s243cdabe d1ab0cdl26e09aa84b4b1r982a4f thabbi4s9d fi029b3e283dl1eeb3d87 -2>1 * REQUIRED
    0399b3P1cl1e835a9055fcscea c6133le4a5ree 6th1f3is934b 41d08ffb2i9e049lf802ddd3 7-b74e>e99a * REQUIRED
    d6eed525e07Ple92a306s756b0fae4c 71cabfle34a3c54aar 07ect8c1h9i7s 4f8i4beledd08e fd6e-1>c40 * REQUIRED
    d9c113fe9Pl0eea167b116s2e4e c3655lcf9eedar6 t3ch6ed4is b1fdc4di7dcel1fad38a12 ffede->8b5ff * REQUIRED
    6P8071l0be04aad4sfd9deb1819 9cleara4d30 8c315f6t06h15d5isa f2664icb7843cefdbl95badd60 8->5 * REQUIRED
    0c93P369931lea3das87010e135761 fc07215ea7le8a302r 0a6t5hifds fi0551eel6d a144eceaccec1->8e * REQUIRED
    4f636P732l06ed2ec3b0a411sfe2 ec9ccc41lbebarf 771tahi0s66 fciabe7653ld1 54-47>a45b1f36cf62a * REQUIRED
    598aPle6aadbas8fce aa5c0le0a40r5ea bat7f44hda8f8i96sa82 b21fi9ee5l299249d83 21945f3->35d81 * REQUIRED
    09b39Pfe8lefa3se 01c7l5698f5f950112e7ar9 a4dct2400e01fh0is7 f9iebldc 5a476ad1775a367f->6f6 * REQUIRED
    9d0dd72P0lbefa4se80 65ef45a2cl97eae05r7ddb5d66e b2et2hdi4248sb f5i2d2e2efadbld1 4->fbb9543 * REQUIRED
    622535f0de37cP4lbdeaebcase75e3 dccbedccb2lde0fa920f9a8r1f t6h66bies f155i8dec5ld14 -6>e765 * REQUIRED
    deaaa9c2d2Ple5b5829c9c838as26be0e 9cclbfef1d1are5 at1h60is150ac0609b fc7iecld5 7c6407-1>10 * REQUIRED
    5487227P318l3e1a2633s00863ed643efe409 7cle0ar ftbe5e11h7fcisbac206 dfie57l1d a949fe7-0>70c * REQUIRED
    caPdl0f1ea0cs7f693710eda bdef7c75l3c60dea114r 6tc7924cd9h43ia8s fiee94af610l88bd 1-f80>3d5 * REQUIRED
    4bP0le6ab03fe3e48a608sd47e92 c1bc890bl9fe2ba41885r cth9isdb cf2450ie42cca3bdl2d 49-b6d0>69 * REQUIRED
    85a87P3e4leas5dce0e772fb2cc 51778d584c79l41ea3rf t766bhdi4s9 feb9biel99cd ->e6a508eabc36c7 * REQUIRED
    fe7afa4Pdle6aa8a8s3e8ec 097ce7leeba5ra1e6 6f9thi5s 2f9c7cdc53fiea0adlc7a94df -e16>c3259791
    * REQUIRED
    15P5cl53e1f0eed1e0a4s2b8ec9163 4c9al119bdae0dcd645a0aer36f1 t85he6abi8s 0df0i702eld53 ->d0
    * REQUIRED
    ca0cf90049Pl5302cf8e7c68ea029a71963s6e 9c309bla8e4ar t3hdis87d f07ie9fdca2ld6 bc20f->8c88d
    * REQUIRED
    067fP2cl57ee595a78s4e 1cl2e9ea8r402a c9thi304s d5ebf212b4ieaa762lda1 b22fac->87988dd50c284 * REQUIRED
    cbbdPbae7869afalf839f39edf44as5e24 c8lbaeb5ea9r12 5t5his feb074fi39e6al090e48d -89>88331b3 * REQUIRED
    fPfel6eadcs777e1e 72c5ff51aec49df504l6e7eard4 2735th43cdisa 8f0a44654beiae9f8bf78lb8d ->0d * REQUIRED
    e3Pd87dlcb1feafs48e 2699dcabld6ecarc445cf0d8e73c thi5s 5a8a43fdief08cl4d3 facc3e31->e72273 * REQUIRED
    efde07fc99e0eP38blec5a88s9b18e27 3c1f3l1ae4b8ba3r 0th340dis fei8667ce8lea16908d3 -0bc>951e * REQUIRED
    Ple35f231baad16sec b3ec2e2decc1leac3r 386e1t742hi23705s 2fi7e560lc03dbd 4d91-5fe583e316cd> * REQUIRED
    132Pl906eaes294b83d29ec c7le1a527ar7 6800th599iccsf81cf 67ae3448fb878biel363d88 2ea2f1-4>a * REQUIRED
    ccbPal4491de128a6s8ff4e036 cleara8d 51477t7afhed98fibs8f60f81 fi97ae9fdld0 -00c1e085>55021 * REQUIRED
    d76e0P6l1eaa26f0cse 71fclefdae4ab8re0 933t9dh7i2d8s7b7 f0faie47415b1l9d706 593b-ca6a5>0c05 * REQUIRED
    fc6f0P5d1lf2646e0ca1bsf6ebda ca4le0f4b3eadcer 1740f2tacefhi13f13s0 e39f9ieldd28 -de8>06da2 * REQUIRED
    05e1Pble0e0aa0c23d9s988994ed6 9aclef1a3a07rb c6c9t4ffh83isd 3aa1fd04i8eeceldbb5eddf -11>30 * REQUIRED
    Important: Y4ou m97ay 3b8e mak6ing use2 o7fa97 automatdedd form0-filli00ng es93o3ftfware. 0T9h0is6 etype o9ff2 software4 can tbrigger ou4r hid2ded83bn spam-cdetec4tion 4sys3t8em,3008f w5fhi7ch will bloc7k you from2 4sub6mit2t6ieng this 21aform. Pleasee selectf3 Fix Thisf78f7d04709c70de2d4ec27b832994 04ba8d8e9b82e6b8a8a2df735o151b8d5re037 dd6c2aod11mc0plc9eati5ngb6 61fbtah7c94e f5or5bmd63 0e6e824einb 6ora7dder toe4 cor5rbec2t9a6d7 tc3he fp98robl613e8dmff.2
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