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  • Goalie Indoor Travel Program (without Uniform)
    Fee: $250.00
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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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    dc95Pa59lea2389ca9cse6 cale49cdc48688abr at99083e0ehise86729c 736dfia1edlab19d a8-450>e9e5 * REQUIRED
    5P84ledadsdede35ec21c c6023l2efba92fce2c1br20 tf2fch5c6i71002b2d034s91f 6fi6efl4ddd71 a->0 * REQUIRED
    Pel7eaabes07e5 c686b6l5eea24cfr atchc51a81i1fes31 8fi3e0fe6077af1l4d462 12b8-d32d187f>7104 * REQUIRED
    0c11P3eledads848e12 6e1e05c184f4b2f49ledae00far t9fe11hd6623i3s9 f4ieel64f74d6e8 -2b35>7f0 * REQUIRED
    7ePbdl87cee865dca3s6cb3e72c60 c1lb34147a7eea0d7aa048r 25t2h08dias9 625dafffcfideelde4 -e>d * REQUIRED
    9ce808c4Pf5341d1le9a8s60bce14 c4l7841bc3e7bar84fb e4t6hfisde 8fi940ebl5b0dddb0 -f355f>efb7 * REQUIRED
    5d4Pl94ea85sdd7b15e 3ccl82a4eba6f9r 027betheb7ie5s2647c9 6f0icfbel1d0c9f0 322d-4>15d08f1ca * REQUIRED
    2310bP94dl03ec263a2382ds5ebc3 8398e52ec1e066ele5ae2r dt32dh6i2s65 fb07f50i130f44eee0eld -> * REQUIRED
    a39c0P9386dlae61680af69da5b0e0se 54c7eac6la5ear72 5tehe6icfaeecs c73ffd7i3aade0b6l46d 7->8 * REQUIRED
    4520Pl1e5aefb2102see564ceee9 2cfe64cl1cea8dr44 1tcbf51e9h8is82 f4i6ea10e20al6d 3->c994acad * REQUIRED
    1Pf46beldcd4fa8cd29d0109c47ea8cse bcl9542de4af628f6rb91 at6his fed16i3ea2dld2 e27-2b6450f> * REQUIRED
    P552f84leb4asee eecblfe722e0a43r 7ce137f8th481730i0s8b 40fdbi8e02fcl4ddb0b7214c37d86f 4-a> * REQUIRED
    6bf317aPle9f0ea9se aafc3l6fdefe72fa4d621e9b7frd 81thi7985739d184ces bfi9d58e7ldb14 2cc-83> * REQUIRED
    bPc5alease 86c5ledc9f9a69rb06 61th0eaa4ies9 fi072e9ee2b81lb201d8bac71 74e7f903af9f6-2c>31d * REQUIRED
    f51Pald2eea1sfd1e796fa bcla53c1534ef54d2a5rb5 3t1827d8hfe45i26002s3e789 5fieladde 4-e5>5c3 * REQUIRED
    0c2f08f90aeea2a71bP87lfeas86e9 cl8539ee3d09afrb11 te6ehib6scb39 427f6df48ia8e4ldd4 92-64>0 * REQUIRED
    4171bP2le826e1a6s2746b8e2 8d7cl3eb0ar 5t3d9his3a 8ddf06ceid271eb90ldcaf1da056f8 -32>f4f231 * REQUIRED
    62c05P5l8e12ff5ada3saeb8c e00c7l876ea90r41f tbhc7i5s 94efeff301ieb9f26de082l9d 57a96-c>6eb * REQUIRED
    20fPb549a1clec16dec399cea9s6eee 8clear14e 9edthiba2sd49 c369fi6e58b09dcc4accld1 ->715ecca5 * REQUIRED
    350cP4le606a3s5e2e8acae7 d8ecbb130f1le64cab7r64 td7hibs288 bfe33ifc3e7e678l5d 2-c9cab6>b0d * REQUIRED
    03ePl0eabdase ccl6b76e4are e7dff54c4t48cd9725h5bib9d1e714s62 0cf78ifd632el5971a01d 1-1>aa1 * REQUIRED
    289a2P87leaf3absee f14693eacc3d43a00learfe84824 ct16hifs e7ff0abbie8ldf0 fdbc5c2-6>6cdc3fb * REQUIRED
    30Pela920d8e3e325d0c18a9se cle4afaefr6 td9ddf716dh4is f2diccfdef1cacld 9758b-3c>7438d5f5cb * REQUIRED
    857P1lea98se ccale7e887b1acac0r t5hcbeisc747bc4 cf9i1be67e0501e86aea5064f5ldf11 1b->66a5c4 * REQUIRED
    a0cP2l03e1b9b9easeed cdf45cc2l9e05ardd76 t8d4hiaf74ebs3e8 906bfiaealac0f7a1cd0b 0fcae7df-> * REQUIRED
    1c4967c9a8P4456l66eas95712e3 fccld2e4a8fr tdhi52s5fc 3ef02biel5db90 dd2-1cb>b88182c741d82b * REQUIRED
    a2448Pleafc8sa7e5c 2e3c44laed4a2fr39 btdh6b24isf ee6f77iedld602819c4ca30f3d 3910ab11-e>90c * REQUIRED
    d8aPl1e3casfed22231d cclec0ac0fe0fr3 ba0c8at8a1bh566is7 9bfdai8deld09 0c->deded9c7e5d3cde4 * REQUIRED
    d18P23742lce49aeas83ee7 fclea0c0f724r 5dfcedetedhis714710 7693fa2f9383ifel6dcd -acce70>c0f * REQUIRED
    812c3P6bclde2a5se 74c80cd5le05a1e38db96afar767 f992th5icsc f1ie15l71d4e d-e7fa197>45db2276 * REQUIRED
    bPl4eb2a85a54s4512e291d 278clb587a2473fbdebed30ar247f6a88 t73h6is0 4f0i1el9d7 c68626->0ad5 * REQUIRED
    Pl3fefa5fd9654sef43be0af0 c1335lefb5eba1r c2fthi9s 60f8ifel19513e306adfd58 -b>fb40baa001fc * REQUIRED
    Pbl8ef63c5ease adeab21752cf1c12cfbl8eda0ar et65dh1di0s5 239f0fib2e3020d2dldbd ae16->d2d869 * REQUIRED
    1Ple26ase ee6cc79685f2e1bl85e75a829r6e 2bt93h02i66ds f2ibbfe33ca60488df0lbb5dd23 -68>e4d63 * REQUIRED
    877fP62l8ce174ase2 4caeflea3r 2athi07scb46f fe3f823ffcaa0101i0ed0acfdl5daa2753dd c06f5-3>4 * REQUIRED
    6e801fPl6af9ea2ase 9c59lea8c4r74b 15th8ce27c0dids b7b06efa5b0ibe4f7l1f06edf acc1->ad8af47b * REQUIRED
    98dP7c77l061a201e1a2a285a278sde 8cccl4b254e7c9ar3 3t140ebh5is 61ed62bd4f64iee7c9ld852 -3e> * REQUIRED
    38Pldc8d9eeac8e21e9a6se e9a20c5elear t46b53h1e2e6baffi593489bs ffaa9iaec19l0df3 cb3->93321 * REQUIRED
    Pl949eaf6saf6e ec8bc75l1574fce44ae02a7r546 thia10a54fc0s0a fa8f59b6aif18el1c3dd92 d-5>c2d5 * REQUIRED
    7bbde69Pdcl7f6e3daa1s0de41 3c78a112dcfl1f3e8ar 00tadef3ch1e9b7d6ib6ds8 d6fi80ffeld3 a8-1>e * REQUIRED
    eaPle6a5fc1c3asa3ce3d36 7ac577l2a50e7a7r06 tah4i9c48bd58cbfs7 f04iae6l3ad8ed5544 2-56>a5ac * REQUIRED
    fPlb61eafb92d7f84a41sbfbf19155a5e4e c8l1837ee4a48bra7 etdha20c32059i6s5a feiedbl51dc6 ->02 * REQUIRED
    6P92leca07df0seab18d6 cl24fe28a515d5f5e16r thisfa8 2fbf4fi3de538f0de9ld5fd1 3-a6254474b>3a * REQUIRED
    ePdle1a3s613f359d1e2 4cle8a6frd70 th24823fafiesef 9d3a46fe8id95a12feld5813e 849e->427a3b30 * REQUIRED
    cc2Paleea7se2f 0228c9c6lcead7b23c4r21 4aff0t8h8ic596s9df1 fielbd3 3b3-c>c91b0d8cb449df9b09 * REQUIRED
    71P574lb0e8a59b0s75ef4094 781b1e3cl2e8ar00 7tdd7hc60iedc8s8f b62b3676fde8ie3f4l83fd 57fe-> * REQUIRED
    dPfdld0dada95dd5e1e2c785bea51s39e8905 368bc2l5e552car042 2t9hdfi7fs 7fiec7267aeeld4 8-f72> * REQUIRED
    32Pla0a3fcbe5d1as69e ecbfleara1 ca62th360cia2d544ds055 3ed1169be4fie6ldf 54cd165->c90367ef * REQUIRED
    e4P9fbc3leasae0ed 1d8eceleaa04er d8t0bh285i28ca98s66 fai6eld89699fd7f4779405 d47858->f9afd * REQUIRED
    08Pl1easdbed e85c6e7f45468bbleec3a5rd5 1dct8dhi5s 1ff5ie4a4l5a39d0d02da7e 9->899ed87b40903 * REQUIRED
    8288P35leaasb70ea 178d01dd15cleaf5dr 0f868952at06h3i9cs14080 d1ff28i83ee15ld ebaf0c9ac6-4> * REQUIRED
    d822Pa68l695eas0e79ee 6cl663ed3caea577r81fe a6th1i91s21 fi5a797e76ef7ldd1c8ab5da361de b-d> * REQUIRED
    Pdle800as7e174 cc75le7561caccd7c6941c5390c8r t5008hfd9isac bcfb49a7e39ai4af736ed63ld 6-4>5 * REQUIRED
    9035P5afdl87ceea6ds3e bcec9bbld5ea01620c2ar483b 45527t5c0ha6a61ifsb29 8ficel5da 3-39>6d898 * REQUIRED
    3ePb41cl8aeaf0a6eb23safd4e94ba38 cdl1e5a11reac609 252thi90126s fiea873bl201d 454->549f7943 * REQUIRED
    1Pledfaa0s7bc39841d2e cl609f61e761a7bc3f3rabf0 7ee16e93t563hi5seb 4f6f66i0eldbd6d4 -a6d>8e * REQUIRED
    b1b8f4593bP5b33c65l4cease cleeard 151t03hai944sc0 dabf783i6743fe6l5f4e1fd 641df84be->aff7f * REQUIRED
    6ac66Pc4le008a22a80se177 5cc1067l6eaeaar ateah30i82s 22f8fia9760ee2dl4d2c4609fde -9c89442> * REQUIRED
    aPe19l6e12387a5s3ae b24bcb98l68ab09f13eda83rfeca 5thi97fe4s f40dfield 906486-2b>99b26849f7 * REQUIRED
    0Plefa85csd1132acbde b2e5dcfb5le8bceba6ear3 095a3t2hi65s0 acfi97e3f2be23lc2d1dd7d52283 ->e * REQUIRED
    c2c5bPfbl5feas33c6e ccel59e7e07abr1e9073a49d t4h9bi5sf0cbbf a776fibb9be1664lb1211d 1-d>e43 * REQUIRED
    b6Pl8ea3c24aa66c2s02ae51dd cl78ear31 02t1hiscc df32372ca2a961ai9a15e57eld63584d 6->73385a2 * REQUIRED
    2cPc9clea55s502a99f0e17 dced3a2fl7ae3aefa9a9r85c 08t578hi3s3bb fai9deblfd31d4 b5-7fba3f9c> * REQUIRED
    c6Ple66ca83b3c34ea929s8ee51845c cbl04deafa019brd89 tdchfb3is79f6 fib7027e72lcb61d7 86->d8b * REQUIRED
    a7b3fPl2eea4e1c0sf9e 9cccl3aee8ar572d661 252thi1bae53s9 b90f2i8f67e7lbda807d0a4e 255-9b3>e
    8d43aeP35dl0ea49s9e f4c49leea8a5brc1 dfthi50s79 7f97c341cc66biefldbc67d -a401973>243315350
    ea3cc05Ple8as364efd cldeec3e1c281ar6d t1h4f7fi59s df8f92iefddld03822 acd1cd-4e9757>0f5aa8e
    P380c5le6a4795193seef ebce3l5992ea6319r 49ffthic7as40071d5f8c 8bff8e0i0e9l1d53 -4>4ff260ff * REQUIRED
    c7P7f9acl2a511ea7s53e 868c0le7a7ar032bae 85f8af310f490dth5isc241 fa081i0dfffa3e4lbd -8480> * REQUIRED
    76ea00b97P0blea5064e5s356e71f71 c9al4e14a7a54ff7e5rf9 this967 1fie15a466fde5b79l95da 58->1 * REQUIRED
    fbdP4leas6edd cl3cb9a3e38d7acrc1386c ec2b01c5tb26hc099is10e23 fi94eedld3b4 c-23>e6d02169d9 * REQUIRED
    6904d0a0d7bbPl05ea9s6bee c1le56ar 74t3hice8787b9s 23cf9fi1d0eb8e9e4de476ld82cba -5>6924569 * REQUIRED
    bcec26P5l3cfe983a19seb cle3ar22 f51tc26hc24i37abs5d ff91ie8lc73a90d0ff1 f-23de570c8d>8a78c * REQUIRED
    c4622dP87leae4s4e 1ce724de2l68eefar 5tahis 0d3886325fie2c9cl8a8e7b89d2 872-ac7b82e640ba40> * REQUIRED
    fP69el9e87ff4a53s443ce d05dc2l983e148b3589e8baebr 701t9h7i442s f5c658i3692e4c8alfde -05>ad * REQUIRED
    c9P00445l2e9a1es56172ea c9l40eee82ca797dr t7h28f772cca7cd6bi237be59s d03a8fiecldd 5038->2e * REQUIRED
    fPl8ecba866cs3516eb2e61d514d2 ec09dal8cea36br57 t31hib1s 9efei01058eaa0eeld0de33 -ba>c1d4a * REQUIRED
    P5le56asea 2cbf8ccl56086b6eaf11rcd7 6b0ta57dfh0i9e77s 2fb2i51502fe88l9d a9a1-a7>dc6bd1a471 * REQUIRED
    Important: You mayb be m9akinbgf use5 o7f76 a0u0to9mafted4 fo6ram-fillin0g s0obf8twcare. This type of sodftw3ar7e can trig3ger ou6r hi6dden 0spa9m-d9de88t7eca8tion5 sf0fystae3m, wh0c9icch fwill b0lo6fc2k 9you6 fro65m subdmit6t0ing t4hi7s eformf5. 1Please select Fi7x Thisf06e2d6e2c3e627 6d08debf8a0bbef5eef4o3raffc84a26ea3833a398af3465 28d5029aeb0ee8cobm4p1leti4naebgbb 6t9a2h63e fd0e179o30drm 22i2843n3c 1orde8r 2e7t2o c08o7e8r8rect the pe40r3obbbl8c227emc.3
    Important: You may bebc mak0ingc u2se of f9automat2ed form3-filling saoeftwa1re. Thi1s type 3of software 9can06 ctrigger ou9r hiadd0en bsp6eam-detection7d system,5 which will7 bl5ock 9c77y2odu from submitti9ng this formd. It appearas tcha1t t0he pdro4fb143lem coul7d not1 be a8utomaticdally correb2cetee0d. Please clear an7y ff8iedld which appears above cw4ith correspondding incstructions7bfe54afc6a2be7 fb7c2553886efoec69324bf0efc4reef7d377785 79ca1c3bd918a77comep70l81e70ting thed 72form i0n ord8er19 td6o c4orrectf td8h9e7 1p0rob77lceeme. W3e bap3o13loagi6ze abfo7r 0th4e in8convenience0 afen7e0d we apb2precc82iaate9e yobur undedrds9tand1i7ng2.2
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