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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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    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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    cPlfe2casb5ede72559 c4l66e18a9ef9r ft0baac1h56dis079 ffac65da4ib97aec54le3d5 efb34d78-0>5f * REQUIRED
    ce0Plb1c075e2a0se48e e24c78l2ceabd3c27c831dabr565f8 tahias 9395f701ielb88d25d6 9fca->1f516 * REQUIRED
    2P6l1ea9c16fsae85ca c316lb1ea4r tchfisfe 6f6378e3d7f2d48aif9bel06d7 a76-775ecc34>4902e7561 * REQUIRED
    547Pel5eads3ed8 9b7ecb13cl6429ea1c0r2 17th4ia4scd597 3f633i3ec3lc1a9de d9e2b5b69-cf>d23738 * REQUIRED
    0d4dP1l8aeea8csed37ca 0aclbe1a3afbf656309r th4d3is73d b2d742fc2fiel4aefbe02d 604-c1>dcc73d * REQUIRED
    eb7Pc349df0e1b0l1ddedaseff99e3 f066fa2c4lbe77304a47br c17t1h0523i2d9sf3 fieel1d30 2313->a3 * REQUIRED
    72c7P1lbea97757as2f495e5 e9d0c89871abdl8019d14e24ef01f5ar t38h8cfd7is2 73cf7ie3fld2 -58>0c * REQUIRED
    4366Pl3d77ff6eea3se48a b2f14c34caec9l0ea7dd6r thai1se8c0 cfb9dief4dclc8ed013d04 592-56>42f * REQUIRED
    660P8649f4ealebea45see feaec8dle46e618a1berdafcd 9bthi97s fie4ld5cc 4701e0b9->0da4b1d6b533 * REQUIRED
    1Pl1e06aee5sea b1a9cle649ac038ra 15th69di6bsc6 7ef42i871elc4d b28ef-947c88386b312e2d>1e56b * REQUIRED
    5afa0f04P1lea9sfde3fce2 a9facad2fc5a1ld6e3a1eae3rdb9e 40c6thb5ies cff7ie3lda ->02cc274d655 * REQUIRED
    17Pce3cl12ad1894920ea037ase9 c1ble2da2324acadaer t1h93fbi81bse a9f3i3ee38blcd4e b6a-3c>f8b * REQUIRED
    P09leb5aasac3bcec cdc7ele10bar365c9 a6th10431i24sa03 fbec8iee9l412bdcfd8 9->a5627898b424ac * REQUIRED
    f6e2Pl8e9575a0609adsbace2 f4d9a9e17clef03aebar 2fth6ie6a04s fi9eceld700da -b1e7e25fb9>9abc * REQUIRED
    P313bl22e21cc5175cc9ef0a2sea527 c22b81ledea26frf2c this9ec1 fcf904ciea2f7lc75c219d6bd a->9 * REQUIRED
    434fa8d8dPdele7a02062s2e9decaa0 d3c5lea5f4aara6430e eetec7h4e4i6s7 c2af6i2ef43eldd 4e->a44 * REQUIRED
    ece3P7lea2se e71cfleaba23dbr e8358544fthbisa18 6f2ie6e561lcdc82360aaef856 9dfa-b9b8fff4>e8 * REQUIRED
    4806P0leaa8dcs5e4 46cb23le7ear9d637 3t80b07hff7is 3f1c1fiel1cd5 f1fdacf00-ce>5ba86d67734ac * REQUIRED
    09Plaa3ed82e51ab4seae8678d ee2cf0e4l25ef84cca45r 3dt1h4bc4i7s28ad fide0349c7e818l0d 7-1>c4 * REQUIRED
    c58c278P5l1e7a3se 7ae5cale7edad7r2 0btfhiefes161239df 20d39ef4a3ie2e63e0l5a83d 167e3->8c3b * REQUIRED
    840d7Pblcfeafb51sd7aee40e 8c1l2e768e67ada1r bt56bh7b629i744779s e4dfieda7l363d022a3 8->2ae * REQUIRED
    69e16Pflcdefa1f7abec4s3a3cc5cb62ee a194cc1l7ear01cce 0teb08h69ifs48 5bfie4l811435bd 1bb->9 * REQUIRED
    473fP1cf7leeas6e3eb8e5bd124ae57 be85cl62a3a5ea0084e473ra t5hf3a0fi8ffs4c7e fieacldf2 a-e4> * REQUIRED
    Pf6lae7a0ca85saefa4eecf 2cl7e55a8c2aae55r4b7645 0t92his7c9e 0b56f8eeidfelfada7 6-8594>6aa4 * REQUIRED
    d68dd0885a0ePcdflea24s0d78901dd6e9beaf cl5fe23a31r292055 2tbf8hids8 bd3fif2ec6ldf6 -f7>887 * REQUIRED
    46f1d3Pl2e11da6sed9 8clea2r b4t3037hdid5718bads5e6df 0ad241a2fficel3154afd8cc28 51-a>0efc0 * REQUIRED
    85bdPbleaba414d1d1e4s7f05efe6d 9fcafcfl2e3arae5978c9da ethi3bfs80 b692fie776lfdc 192->1ffe * REQUIRED
    fP9cbf8e7bb14ldbeca5s579c54e4da 7cd23l2ea2brb 5f01t1h7bb4ais e8feie4a867863c3l56d1 -c>33ae * REQUIRED
    081b6f4P3ccb1l70ea4cs02e ccc52lef8dadr t30eb5efbhi4sc48 fiaeld202e1601c11d a8-6>9eb8d7919f * REQUIRED
    46dP15b56ldeebbaas2bef04ce5 cldeba62d3ra e6ct1395c5hifedds5a02a08 fe9i2596bbeeld3 2-39>68f * REQUIRED
    c852dPle3ae0ase9 4fc90l92e787852fa87acfb3e8779r t74bh2i4cs0d3d01 a23856fieclbd20 8480-a>55 * REQUIRED
    7ea879P6lbbbea5a48d7ds5e a9cblc457be335a5203r 7dt2hib1s95 9fb7eiel7d f67c4cbe7c-785ea7a9b> * REQUIRED
    7c1fa34c2b21Plae3asf5ebf34 cbc6le3ara t3h878i066s 8df7d2i2ec7365e40lc8bd686af86d5373 15->4 * REQUIRED
    9bP4dlea2f9s62ae6 clefa89r 36t1fhi2s f91i7063ecb2fcdd6295358c12da7039l00deb 8b->670ae522e7 * REQUIRED
    09Pleas097654043d1ef fafcld4ea64r 920e8tb8h170i0b7sad b5fiae3ee7aldde9d77 -1a5>3e62e6dcb71 * REQUIRED
    P33l731ce5acfse053 cl7e9b4930a20c1fc1d8e48r5 t15ch2ief17334s fiede1l1785d 01ae1->86f36c821 * REQUIRED
    9b3Plbde6a1sea8 cl6d92eaa83fa320r5 1b7tah102f02isbfd59d5b fbbeife9bl199d -d>efcc2675121439 * REQUIRED
    Pc2e7c6blf2d4e5as9e 25clear 8thid7s2439 3fa6e400ee151b9e3d9di3c5cd6adea8ld -9>f3f223344567 * REQUIRED
    4fPd209clee1b00a35sb87e43 bbb7clbbece7a81r 19t4f21h1ifsf815f35a 2af132cie2lcd bf567-f5>9f5 * REQUIRED
    3Pfl731e5ca762710s2fe 53dc64lea2ar381ee0a69 9tehifs4a6 fc05bficfaf44026cefl8d03b 0f5c428-> * REQUIRED
    P51lbe53a18d4a74s65edd3 77afc12le6a1brb 203e6b0tea7a167h41490iba8b8c6s adf9ie1cl4d -600>94 * REQUIRED
    abd7Pele526a1s5e549d6fd81 c532l6010f0171ea81rcb2 t3h10i45s 9756f332c7ei5el49ad1586 5-0d37> * REQUIRED
    613dPaeaale7685efa5s28f36e ec32l28afe6ar eft86h681ias85461b f691cai75del3da ab-959>e4ef4ba * REQUIRED
    dd04P4l9ea6a56c7eebse 7b9fc426af2lcebeae01r37 15th1i017s8f df17a3i9e76ld568 -b5aa>0f362d00 * REQUIRED
    601f9P9d2lc3b69bea70bd300s85e77157 dccl8b78eare a232tbdh81ia5s fia22a36e2lfad2 -d>3da2ce19 * REQUIRED
    daPl6d3c70fease1e cle5c9a4ab99662017f76r1d t3h7is3 1feei7e056b82822324ac8ld8 b6->1cee5bf51 * REQUIRED
    7P17la0eas4e6 6abcleaar3c3d1d2d109 37thi7e8s3220 fi7ea7ldce6e74 d8618ebc8-45c4>930aad33c05 * REQUIRED
    1a9464Pclea1a937e353e16sec5 6cbfbl9da8aeda9r 544352tdf4hi707asa 039c758bef58e3fi26eld f->e * REQUIRED
    e02P73cbble6c1aa3d2se0c7f6d3 4ce1lce95c4aedarf7a71 5120t19a87h76514is 7fi9e0bld -24b>9e0cb * REQUIRED
    04P9bl575af799e4as425e ecfclearfde1 0bftaefh0is ee1b8f32f7857f6i54e1cdfddld f65f8472->b4b3 * REQUIRED
    9443d9Pf0ldb7aea9ase9 c045fcl0e4e84079ab4afra40 850thb7idsa 2c8a9cdfie5le1d5 a0d8c7->51cfb * REQUIRED
    7c777b9281f2P9le0a1c418s56100a5de1c 7cl4291ee9003a1br t6hica77s f3062ie25cleba369d98 -f>01 * REQUIRED
    P01dleb5af2afef5bb9ase50e6df1 c7dl86e5ff53e95e437067dacr 9afthi4s0fd ca0bfdbi0ee21ld8 1f-> * REQUIRED
    589P23l16a46af25b3e9aaf2sade 00bb6cle982d0a3500r d40tchied5c7861s 56fi2e871l7df9c 9->89a8b * REQUIRED
    88f51f4P31e3d9l3cee90aasa773dc45e 6c62l88626ear t9hi88s8 fa6263e3di384el46ed5ac2 d->78da3e * REQUIRED
    2060Plea8s4e3be 37aclbeeaaf2r9d 224atheis0c7ae5f3d fa388ffdielaf27400aeb919dc 835d44a1d3-> * REQUIRED
    2Pfdleeas7c5e4f5 4cdl12e4b62e9a0r6 89369a05td2hies73049 51abf2b7i8el5fd1e -dc2>2ca5744d943 * REQUIRED
    47b04P6eb306ele232a7se6 c3le0b286a926r6 edc3dd6cthia69c534sf 23fibd3d8ceb7efc53l28d 2-f>95 * REQUIRED
    5efbP1le2edac4a17bseaa dcle05f6ar2e52 3b5th991ei5s55 513fi573e3fledd4 cacd4ca-02d>57e275a8 * REQUIRED
    477Pf22bc429lde63ase337 cca714c4849l3ebad165rf82 011th656893i42s9a9de fia1eld 15c-3>29892d * REQUIRED
    c4163bPflbb2a1dea2f0sde cl9ea3frd0 th66394b0610a10ias 4c87a31befdc9di4d5eled -4f27>1fbd677 * REQUIRED
    7879cc59dPlef2c5as3eab7 c6c40ldefb7c6aa5r 84tf4dcba247d5e344hi9s079c8 49fie0eelda ->cc9503 * REQUIRED
    6f44131Plc9212e2548a2bf48f80se7 6c9l64ea63rc4d t7b5dhi96eds9d a65f6c8fidfe37ldb5 8-7>66ea1 * REQUIRED
    74aP1e2l5a2cbea11d369a7s4be e7c9a544l0ce17a1ar bef103tc25hi5f09s9 fi2elad 71-e8>235ba197d9
    7Pl9eb4938asb41cf09e cal4e71e6c5a29ar15 thdi9cf114bse 3f70befd891i2e1bcl0d66 d35e-d>11d90a
    2fa7Plee90508aaa50sfbea96f6a 8cld5d4419e223af0r 87dd9t048hafcisc08d 9fd9ield 0e1c->e052344
    18P85fdedlc1eeafs5fcaaed37 c9leee96aara3 d2aet1afh0i4s1 739f9f58ei333c0e35flb954d 8f5b->be * REQUIRED
    6450P5f8l51fffa6beb426f4abs17ef 42c784leaaar1 t8h89235isf fiedcc5e17ld3f8cf64 -bfb29>036d2 * REQUIRED
    c4ed6P2f3a6d6lf0eb2b2e82ff6as33eb2 8853clea34d72r 4at5hdi190f121dsa 05a5a2fi3e2a8l3cd ->10 * REQUIRED
    4fa50e323dPfl2caefas2e cb9afd65ld5eaa72fr 7ddft768he6ad68i653s eaf3ei99el8d1 6a62cc2-4>055 * REQUIRED
    dePl5ea6dsec70e cbb4l447b4efcec7b55038db2a3e2ar1 t3hi2s6f f26ieef7l74d377d f73bd-f>3c04ec0 * REQUIRED
    20P50dle19a87649se7fd c15c17fle6d1a2970bfr7ae4 172c7thi7asfe4e19 fic87e0bclda e->53bc48cc3 * REQUIRED
    28f7c38cP7l86eba1cd1se0 cdlceb48af8rcd 3e5th85ci83s 215f66b5ee4cia001ea7ldd09c 4->0e242664 * REQUIRED
    435212ePlbe822ad5se cfef95eecalbeab7046r74725 ecat2d475h59c92is f3ie7c0c1ld 19-33>f84a51c8 * REQUIRED
    2P3clea7as0e 6ec08ale3da6r4 dc9cth7id602b2158963s1 59100e4fi3ea3lf0d4 9362e6-ac52e>d28d78c * REQUIRED
    e852P5a2lae3as10e6 37c975lear29b tf5abh4f6cc6580bais cfia14ae8l4354acd38d2 2-33527>fd3f374 * REQUIRED
    4P91le76f28a122se 1b6e7ace62cle57aa1r5 t26hib7s f2fie6f22598l2a1d9bd5 2-693d0f725a>108e9e8 * REQUIRED
    Important: You may be makibng390 8use o5f aeutomatfeed forbm-fillieng25 sof9twda2rae. Thi25se typ0ae ofb sdofbtd9waere can aftriaggder oau35rb hidfd0efn sp1am-detection7 sys5te3m, whichdc wi2ll b32lock 1you from submbictting thib950s form.13 Please 34sele6ct 402Fi5x Thisf37c5c38edaba150 9b319e0ce71548c73301f09e672f450ebebbo5r62b8b0e 2e40c0670cc1oba68355me09p2le5ftic731ng th0eb f80o1c7rm c77in fo8525f8858c1rder 93toe3 e9ccorrdfe6c2t td0fhed p5r8od5b4lem.91
    Important: c6You ma09ey be1 making 9us1e of56f auto9mated fodr1m-5fillfing s7oftware0. Thddisc type of software 8can trigger ofur5 hidd3en spam-d3etection esydstem, whiech will bl5oc8k you from submi7tti3ngdd t3his forma. It a9pp4ears 6that the 5problem cofu43ldd 6not be aut3oma7ti6calldy4 correctefdb.0 Plefase cblear any field whfich appear7s abov7e wi7th corres0pondin0g insetructiofns8ba09ef23 6b9f9b73b16e9abafcca0446ocr16eb352e7849232e78dc0ea7 a2a0caf47e1dcco5mp7l7deti82cneg the1 5f55ordm ina ordceferb tao 0co6rdrect the fprobl0emcc. We ea3pol5oc2gize 0for 80bthec i7nconvceniednc5e761 6and 6dwe appcreciate yb87obfur8 unbdef9r9s6t6an97ding.
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