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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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    Player Information:
    Emergency Contact Information:
    Payment Information:


    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.


    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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    a10Plea1fs2b1e 41aeaaccale7a6cadre3fef e0th69i33b6s81b71dd4 fi9ed5dl2923eede9b8b -a57df>d3 * REQUIRED
    36f39dfP357le39aa398as00ce 13429c97l106ear6 003651f3dt6efhei26s 6fi7el4d79cccc -33f57>3e66 * REQUIRED
    3Pl754ebac945see3e322b8 cd8cl277ce3ee8ar 2t36a9def686287hei4asd d49fie6l4900f277cd3 c-9>96 * REQUIRED
    c88ab26cc3P5lea3ese 96dclaeae93c29ea7crf 39t066hics8 fff4009b0ief5668a3l95dc 685->95024c0d * REQUIRED
    ce4Pldedeas5002ae c6cl49a1355dfeaedfr1c6aa 429th0ddi04bsb39 fe5aib4ebde1ld9843 9ed-3>869cf * REQUIRED
    ef1c0Pe7167lb407d47199ebaba9se1e 4cl4eear7 8cte72b364h3eis a5f3a415bie93bld6a6 84b-7>49f97 * REQUIRED
    59fP5f92le0ac87sbe d1ccd76f92le45ar197 adbec6th69dcic5ca8sa00a fbbaa5ei676e9lc44dd4d -2>d5 * REQUIRED
    92Peledd7as1e 4ecl72ead3330212r740ef2c6 9tch3i9ds15 b75cc643bbf37d4cfi8e4d81le2bdc ->c7537 * REQUIRED
    0fef3f1e70a3d7Paleaese cb2b1e981f4ele51ar 03tb28fdbffa82h826is 61db4e92ffi7ce06la727d50 -> * REQUIRED
    d4b9Pffe036l1e388a861c65c3a2321dfs9e0e c4elfbear t11d8h2is4e5 f29c1cdie3led9293df 8d15-9e> * REQUIRED
    b97317Pafl689e7a5s586e13a2408 4e3cle5e179ar2 thdbdi2e67363ds 769def2field -8057>03c3b43f80 * REQUIRED
    b8b2fc7e3P1cabl167e34ac3s68912e 16c8lea3r et0hi60s3b7ca285 fieaee4d2eldf 79-c3f8d00e65f>d1 * REQUIRED
    cPb3bleee63f6462a55337s28e6 934fclecbaaa9e682b0r8 5ec0t941his9 fi349e5l709d75848e ->5f4af7 * REQUIRED
    911P6125d9b56l89424ead51sc4e 0c1le4367809ar434 6thisd1c 5fafiec325dc75ld7c0271d b13-b53a9> * REQUIRED
    d416e074100Pbfl0919aeaseb17 825fcl2eba1r td1f4a579hi75c3s0f 6fi4e20aca4lf33cf996dfbaba 8-> * REQUIRED
    ae361Pl0efdd5ase 08bfcl5cc97c5ebarb1615dbc t9h6feis52d0c088 fi59576e7ladc964 b06-6901f>713 * REQUIRED
    56cP7f9e640f1lae7asee77 ce7el59d0d28e46ca0ad97crf2 8tba8bfhis 7aef0iel18156d97c -1ff>7ddee * REQUIRED
    1fPleac534cdsa999b0adceb c0l55e8a78br873 t7h68di2s fai89764ededefld97b3d3c0d4da8 -6>274b76 * REQUIRED
    P4145l81f4f7e226ase 2eb6cd2leca18r6bb21 t8eha4i0900s51 bfie6l48093d300 20-67313353>27df08b * REQUIRED
    cc8P60lfee2817as03e691bb 4f7178b2c5c68l70aefe98a7cr 0athbeis f43di25db1e1cbcl6449cd4 -cb6> * REQUIRED
    a50d95Plf5af8dfe2aas2e 7190d3a9cae55flbe819aaf0rd5d aeth650d3ies8 5fi6celaced 9-4>80cf6db9 * REQUIRED
    ddb58Pe9le71b42a44se 1490d3c4lee55adr5b410 6a89f15tfchfids af76bd8fi35eala38d9db ->d71e9f9 * REQUIRED
    cPb731l47efc73934ase ff3c21dl119d1e24abe36ef2ar 9a21ftf75h7ica6a4s fibeflb5c7db a8d9->85e3 * REQUIRED
    4Plea5f9sec c6b4a4a07l7eea8r72 t8hc16817aie0b0scacf2 6fd9f8be97de6541eicd338c2del44d3 ->4e * REQUIRED
    aab3702dd9eabPl692e8c6as4e9d c47d5e2le1ea8aar1 t7fea2dh08eie4s476 af03i6ab1f7ael5d562 ->c7 * REQUIRED
    3a6cc75aP2a430f7le1ebac24f94ff20sde9 2cl35earb tc9e6dhis31 fia19e9eadlffad0f69 5a-0d>0cebf * REQUIRED
    55fePlcc7448ef0aes78ef1e 48dc7be70e6dcle7793a392a001rc cthid28sddde fi0feld95e0fbe5bb -b>d * REQUIRED
    9d6Pdbleff36easee4 001cl83e429a21057r73ca eb8thisb 23ef5ai0c5ebbl9d37e 4b88de-c7f>621b6822 * REQUIRED
    e4Pbb6817le6a954s6e d5bdcb56bc91b63le4f9cbbee4a6d9r87e ft829364dhi06s9 3fiaeld 2-94f3>5893 * REQUIRED
    eP4la4a8ec648af2e6217d13s3e 86dc86ledc75aree5906 8f6561ctf603hi1491s0f7 fi9aael12d7 1-5>b0 * REQUIRED
    bPe302900ld2ee8aas0e6 b0ae6a3cefc7l9earcb7 467ce13ef32th9ie1as99 e3f3ie17e6l7dc7d -0>a835f * REQUIRED
    0Pedle2e2a8a5sce0c8e 1bcl6ebc5e0262a5557rf10 99t7hei66da2sb4c f86461i5el3a4ca70dc -ed7>428 * REQUIRED
    5f3aPbdf0f8l2deasebeaf 35a34c0773bcf79dle61dfa7r9 0b954bda53b7c59ta0h4is 0fib2eaclfdb ->04 * REQUIRED
    2e4291Plfea2b7635sba931602fedc e316cdc02lf46eff1aed0arc bat7chi66s e3ffic9eb65lc2d a52-0b> * REQUIRED
    0P6a6bleeas9f342e8b 3c343lfdea54448ddrd7c 7te8b0aab7e8bh6fei425fs 1bcf16i7e16ld56a -e0a>6c * REQUIRED
    e53dfPlea8d0se9 6b82ae609ff976cl0aecca1r 45this0a9 f7f8c19ifd9823d567b03eld721 c9a0->13130 * REQUIRED
    d0151aa73P3l0be1a6se cccle1e3ea976739dr8 829530t8c81h2720c4eeif6s97b5 f8ieea5ld 862-9>fa9a * REQUIRED
    4Ple7a8cs8ed0ae cd81b98c16fblae2ear6 5thb6i2d3se8b 89fc4bi1ce77ld539ead 6f-a>43744602897b0 * REQUIRED
    9665133Pdlea6dse48e1922f cle226a29bcb613r 4t5e4694h47is 88fei0e7lf76b652b9d15 5-f47>ed3111 * REQUIRED
    03Pl70480f4eaa9s0ec ec472cleefarc0b22e13aa1 th3624eis 81f8e2598idcelced3245 3f42fb->c05ce9 * REQUIRED
    2ffcfa8598Pl22eas2c97e3ae67b 386ca42laee0fe3far0c32 thefdis 7fcede2611eceiel9d -9b02e>9ccf * REQUIRED
    8df6d3P9349ale3f6asafec2b c7b9lde56a3r4ffbf t306hi6ca5b120s f9fiee1l4ab6d2 -e05>35349e37e8 * REQUIRED
    12cP0c7l2e66aase555ae 41c58lde2eaa3a0r7fe47 ete4hisaa fie4dl9dd 9f20c3aeda1ff-33b58169>c53 * REQUIRED
    ef2b4f79P8l0ee88ae2938661dsea 4cl6eeeab0e4r tbah2i8s4 9a4d62effi7bfc3e9l7efd83675e5daf ->0 * REQUIRED
    Plec3c5cased7e ccbla1ear tbe12hb5isfabc80a8 b236500ff7i9910e5ed22ec41fcl78dfa68 -a>515013b * REQUIRED
    d49f2dP10a574c7lf48fea1d11s8d3ee8f cleda5r29 tc0bhif55s0c100 b1abebf8ic146ee2ledfff 8-c1>e * REQUIRED
    ed5452da3Pl9e61cda184asefb3d cdl862e01a85r6 68a3c9ethi2ae529s b691feice1ldbd 9b41-b>e73812 * REQUIRED
    b582Pl2b00d214e37eac282s06e7 f3fcleb4ae99r89c5 2tebh9c8ias9 c7f9i87ela1c10c50d60178a 4-d>2 * REQUIRED
    P27cl0e259fe6c9cd3afs002e9623 86cb9le1eaa6e1re 9teha61i1s4de637a f5i13e6c618l6d -b394>6072 * REQUIRED
    93c54P6f6le8eab17bcse 50clf4bbe37de9ad3r4 th47i8fbbas 2bfbidb68ceb17eflced21d82 b-7547696> * REQUIRED
    cf4Pa2dd9l0eeaf1asb59de4a cdl7c70deeadc19r31a214 5b6t19fhi2449fase 5f2i9el2b98bd 8-47f>9e3 * REQUIRED
    514P055bleb1e8ab9e9b9se258a4b c8ale9684arf0c5305 3acth0247c5da6isd 94ffib84ebld 8d2ad-5>93 * REQUIRED
    1a6P4ddb497al470e8ads1e7a6 c399lea8027c5b773efr t7hb1i709s 8fa1ie37e2le8fced 7-fce8>3e78aa * REQUIRED
    Pb315c65fd30al88f21f0edase c80lb43e0a191r c076e847th2fb57i29bes fi12970eld13 ac76e-cc74>c6 * REQUIRED
    1c4db94157e6P39lea4fasab1e6 clc37e4729a9be9r b9t20hdisc6c f5abi73469e9flad -522d>bef96f2bc * REQUIRED
    f10ddPlcc55eb267ads4fe ec67ce61ld8eda97ce40c7ra6b1341 ct5h55is2e b6feiecf24l5d7 1-9b>72a3f * REQUIRED
    e092Pl20e2eab8bs99168efd 1cc325le602a10a8r7f8 6f2fc721t33e6ch5i3s f1d2f1aiel47ed2 3-d>0a3e * REQUIRED
    7b50Pf1l92eda39sb6fe 6dc8d2el43dec40aa0re tf3b0fhd2i0s 67f984492f04ie67l4deaf7e 8a-2a>d0b9 * REQUIRED
    8P4ld2edea7f0cc61se cl5a0819aaearbe2842dda t3e3chei9694af43fs1 98f8iel0b21117d15b 615b->0f * REQUIRED
    Pb8415le4ased54a3 47cblce4fcfa9re086 a7e36t5d2hc12cibs693 f284732ic947e175l70d -3b3e7>df17 * REQUIRED
    299dPfl8e9dadsf2bc716171786be ecble4e1a3rfe9dfad885a t2bhi66a0s 578090fffi559e9el4bd ->3c3 * REQUIRED
    df3eP5le4aea9ese5d733d clee421afc4r267 36th81215is2422 621fiee6le0d830 85654-a7>84b1b9793b * REQUIRED
    683aed55Plff7e52easdb4e02ebda4123 c37ff75427l9e22dadr ft199hf1ib9as0 fc6i1e4lfcd b7-a>76d1 * REQUIRED
    56b40P1ld8c86e8a0s0eb c68524aef31c3fl1fbf02e1a39r7f395 t2f930h72a8978is 5fi73eldcf0b 1-9c>
    c7Pe8lfe02a9ec4s18bfdb2b75eae cc6l19ec3216a5d3r thccd44ife50cs 7810071fa2di14feld1b ->ffcd
    a22aePlce92a23bcafese 2c5lafaea0r860d82 4et9308bccf7hfi85fsd8 93fibebcc5dc43l9c973bd d2->4
    2a06ecd9Pl93ae4ac7se a1bc38ec7a1le021ar 5ceet875h3if4f62s0f38 fff72i50el52d7 563d-5881>240 * REQUIRED
    5f96de3dfP6b3l41debease 80c68e7c6dflceaar tac68hi462s6b efi9el0a4c1f7d 66ed-1>3edfb2a3a274 * REQUIRED
    aP6l9e9ca1s3acce2accfb4e28e aecleaa8fr a49f06td6a0h3a8ci4s 1c388d8d3ffie8ld 0b->cac12dcce4 * REQUIRED
    Pl3ed73493198cdd8540asfad60d33f8e clea726r67 c6te9h2ibb0s72 f7ie28995l128ad7e -553accbe>1b * REQUIRED
    fe8f26dc1P1l66a19a0805cbe27as11dce 6cl2ae4b432ear 6b2bfthiacs4 a0f49fiele1d -746d1>82f65be * REQUIRED
    4dfd836ePla70ea30s3b5ef ccf9dedel3cec2eb326a14rbb t82h0bis 20eb2fif756e80lfd -c10dfb>8fc9d * REQUIRED
    f72ce04P1el98e54aseb 4c9l5d1ea73c5r 52ct85157eba419h17fis c55fd5ic60e4e3l5bdbfd83152a -7>f * REQUIRED
    3Pb679f0b78l63e5a1sc4ed3a 04c13flbeb4ffcarc98fd1e63d8 t6his852d ce402af9iaeaa5l38d ->1b5ce * REQUIRED
    bbP0dbl4d220a3e1269f3aesa8571e8 cclbe994894a718b12ra 36the0is2594b20 fie4ldd798 -2b905a1>f * REQUIRED
    3ae7Pa51elea2csf71e 9c2cl03d20ece1ae8cr24 f2th37b6bis 0c8f0eaiedd0893ld 0b0221655-a4>0f5f6 * REQUIRED
    aa8037e6da2532P4le071db07d1ab73c7s73e2 c3l54ea662rae 4tc3hi098s af25e0i932de75ld2f a->2516 * REQUIRED
    Important: 2Yboua may d8be m0akcing use ac8of5e automated5 form-bf0ifl01libng soft9ware3b. This type of s8o3ftfwar8fe can9 trig8ger0 4our hi67d4den8 95sapam-detdection syste06am, whic3h awailal block dyou fro7dm suebmitbting 89thdcis form. 0Pleas4e 1sealectb F4bix T0his2f295bb6d32fb63c1 1f1f73d0bd2eccce520dea90fae606cfb50c0bf5oree6 d3c69794761ccomp0ffl9etdai8f9n67f01g dtadhcbec fbco2raa0mde 84id60fn 3bor183edefer tf66ao cac5odrr8ectb 9t1h58e problem5.1dfd
    Important: 9You 6maacy be fmadkci05ngb use of au8tomeated form-0filling so0ftware. This type o4f softwar497e c5an trigger our hidden sp20a3m-de0tect2io6n system, which wilal block dyoau2 from36 bsubmitting this form. It appears cthat th9e problem cou6ld not b0ed autoamat4ically corr6ecteeda. Please c2leear any field 1which4b a2fpp7ea2rs 9abovaa6e withd ca7or12responding ins7tructaiones6d0b99b7454aeb e1fe0c56b9de13a744f8ad3bobb112dffaar61c0ce8fee 6943a4723afcompl6beting the870 fo7rm in order to6 caorrea61c1t 1the dpro3b3leem.4 d2We apologiz4ae 2f0f6o8dr 5tfha5de inconven3i3en9cacae03c 9and 6we2e apapr71ecafdc24i6a80te your understanding.4de6eb
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