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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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    22fd1790Pclaeeac1sea86598c56d caleeba564r9 t4hiad3e1se 7cfi6e8l09a11d5ba63 -b8c>e6de5edc0d * REQUIRED
    f2726Pb83l8ce3aesedddfc9 cfbl7052453ef64a9r28 6tfh2is ee66fi3544eladed748 135-d7f>2266e82a * REQUIRED
    d48aa6201Pl5e1e47a5bba6ce1s0ebabd cl4ad316ed95a1rbdf2eb th46b4is236 efd88cdfdi943del8d ->c * REQUIRED
    2Plea19fd4d1bf8241sdb89e9c3942 fe6ccl0ear f2afethic51e228sf f1i355e7aab40l5d b941de-5>fa11 * REQUIRED
    1b87901P8fl1dc0d63ce1f2ae1aasb5f5944eb2db cle206a76r167088a1 t4ah0ise62c fielfd d-a085e>e3 * REQUIRED
    187d3cdP36l3f0e5a664c45ce2se46e 5c57leef4a6r d23t3hd47180d7ci897csd fci1e2l383dde94 19-5>a * REQUIRED
    8dPl78e29eae57sfee5 ec85ble9ec76aar d37481f69ct493h7is7c af2bidel180673281d6e7c ->3b3c23fa * REQUIRED
    2eb0d2e1c3d3P31leas3ec01c 0c0leacb0r345eaf t34h3b379faffisd8c ed4f8a646ie620ld fd8-c>b801e * REQUIRED
    9217Pb25b4l33e720a4c76s0c7e9 a8e2cce090eleaa8a6e8r 5487thfis c01efi080el80d 58890144-5b1>b * REQUIRED
    03P8e8l2eeasb0e54 10c69f1elaeaf05f11ra76 23ae9t2heis ceeddf530eiel8d05a2 2f87d-e>0cfb47275 * REQUIRED
    4d52Plbe3afese5f566b8efd1 47c98l5eeb8e71ab9r 1f5t5h290i6s ff4704fi7eclfbd -c38>2b79a007cd9 * REQUIRED
    6083c93Plefca3sbe82 bacl3ea9c284cddr016 thais0c6af4c79df2 fe357i72d01el2052e18d 9f1395->9c * REQUIRED
    dbf179bPl74ecad9sed8 c5cl2db29deffaa913d6dr 23f1t2hib6e2s0 f759cie28d5a99dld8ca75146a ->13 * REQUIRED
    5a7b6550Pc227l3e2a7ds52e calear7 thda48ieba9fes fb56i4ef655l3f6c7d ab20602-11d947d4>4387c9 * REQUIRED
    7f894a9f29P16l9e1eas85583ece cb64lea01d99r 7th634215dais624 859b03f0i649f6d0532f84eld ->36 * REQUIRED
    e47a912P0ce2f62ble5af5se7e9 bcle2ae8ac7rb bdthb28d4e9di3s f342f79a205b705iael40969ad ->c05 * REQUIRED
    4b4712Pc188060485le2ads4ceb bdca0l7c4ecfacr36 bt8b4h84iscaa cf62bc9adiaf60e2cldea fc2-37d> * REQUIRED
    Plce6abc20445f55dbs195ce07 9f9ce6l8eard8fe96caa ft3hde4i014s fi23e5eal87dacda ->53b08752b3 * REQUIRED
    e23P3b8l547afeafs6e09b0e64 5119c5da8l2eaar1b2 10thd0i93991s262a3a7f4 d9ff7f6i8e6eabld -0b> * REQUIRED
    0P4de7289c2e2ea8a7b2l2ee1as0799e5de 1c1l3e5ar2c9e87 this0 243f830c61fdifedl59da 08b-febe7> * REQUIRED
    c74cP1l9a0e7da1sea cl2a72bea3r 7ct25hi1f24s415 5998fib9efdeldf8d5c -5056a54>f9e130fd78b901 * REQUIRED
    d6d693P4eble8a419sec c9lb295dc89fea4r80b5e7220fc adf42t0h120a2bisb 6f2ec1ie2b09eld ad958-> * REQUIRED
    706Pe0lbb9130fd34efa4sae4 c70lae5aa1d0r98 athi9scf4 9bf156c926d55ibde663ba3bl5d75 -0e97>81 * REQUIRED
    98fP7lea14s4f9be082 213dcc6leeeecaf45908a18rd13d4 36ebc31th0is0 625fe3c6i01eld 4cf-3f>9608 * REQUIRED
    c661c5ac3Pc314f6cc16abdf0de4fleab1925s38e a6cbeaclead5ed5br b7th9i3s0f 5525b9fdield d-3>22 * REQUIRED
    fc7Paeale660ea1fe3s31e55 ca2ael07e16a9r 5e47e91t44ba7h21fisbe2 ef7811ie2l3c8c4aad9 9-f>79e * REQUIRED
    Pbl87e08bads0fceebf c47d15l512500e2f0d9are1 3t1407h5i0sb4685 c53fieladb61 -42a82501f>e734b * REQUIRED
    230ae3eP769ed4ele5aa2c3dse6 d7dcclac7ear t28h41is0 6e30cfbaciela9208f1d 6a-ddfb4e2>90e5ef8 * REQUIRED
    dP0le3924ase70 7ccfb9558clee67d0678ar0 27f0914t1h2dc9fise44e af08a6ie88la69d9cb ea-7d>3618 * REQUIRED
    1d70P76b0le2as60d42850786a2961e46 fcl2dec8ar t38f6h26803255a8is f46ce4ie86cl9d50400ee 0-4> * REQUIRED
    b57ce599Ple0aseb 7094c1ld0ac65be6b6ea4e3r2 0te8b3h31i3970dbs fdd1i300e80f13cc5fld ->a8e2bf * REQUIRED
    d7525Pc8e4l35aec3af3cac22s457b11ee ccle4ced6bea9r eth0i1as afie2e304e186l12a3dd 7-096655>2 * REQUIRED
    78c13a4eP9led5f459dea27851dse c8f2lde529acar eth13iaccs2 f7f3i345f3e3eb1fald 8-63>056abac1 * REQUIRED
    c85104P6d2ledcafc4fscec57e65fafb8c b9cl88ear1 b1t476hisc f4951b69d75e6ie3lde1d3cd7e8 87-7> * REQUIRED
    Pl9fbbfea0f96b6b60470ff0a11c61d082d9bdfefs6cfe ca7le22arf 5823th7ais 19f81cffieal0d 0da-5> * REQUIRED
    c4605Pd7dbfelbf1ed1ccasfae 338c2al6dea7e8rcbe23 0t9b4b987394dchis 7f28f5ice60l61f924df 8-> * REQUIRED
    5764255b8Pc6lc298ea81f3f3550a2s626a08e c2fel1efa326r4 tbh00isb1 ae9f2iefdld5 0-40>695885a8 * REQUIRED
    7c7a72P8a293le5a0417c4se 959c2l6e0a40dr43 0thef1ias88b15a fi9aefl12eb023cd 8-04525d>359b93 * REQUIRED
    eb85504fPl8ea5sed72 aa0de1cc0lead05r8 9t6530hc50eec112fi6sc7 6fa46ie09cl48dd d-e5>224e69e6 * REQUIRED
    83Pl8aee9463ad22d9se 8calc65efdb01c8441ar84aef ft9ha366ifs11918ea f959fie89eld d->2cd4935e * REQUIRED
    d8442e8d4P7lce0ee0e2ase cd3le7a5f5arad87ae6 d5tb69hib87554s 558cfa951ffdi9eld2e190 e2a7->4 * REQUIRED
    42aP43lda3eab520s5e84 fa536e40bfe95bcl82ear7 dd8d9ec0teh1fib6s fiae7f001l1fdd1dc1 c9->26e6 * REQUIRED
    e2e754081P7lede63ca1a5s65ed clceearf02e 705tfh89da75is 6691cf55d6bdife2le99bd3 -bcb1a>db03 * REQUIRED
    a7b5Pclf3b53eaa1aas6446538a539e 0e6fc2le0dfbefd203ear5d tdhis1 5c7ceb22fi641eblcd c-c>fbba * REQUIRED
    4P275leas6e8ea 17ca0clc3ea9fra 1882t2f1875hd68a61i4s1b1e1 6b4efifelf00ef84bd521 -f>cba5847 * REQUIRED
    Pd6l9c86eeb32a7sf87eba6861be213e c4a1lf0d19e1dar9 6t7h3isb7 733cfi1ce711d480c64lad685 -a>0 * REQUIRED
    a6Paflbe69asbe c2b3l6deard72 t65eh38ei45es48 1f1ie268ael6202f30db6dec0d6c 1->a2a6e23498fee * REQUIRED
    93f6047e103P77lbeea7daa1b88cf54041a8ese cl8e6ar2c8c40f 4t5hiad25sf dffieldf5 -e371>6a4ca95 * REQUIRED
    P8ele7e91as1c5e84f cf65l8b15d6d41564cefd3a482dr 2abth47d8b2is4 fi41f07645895e5fclcd4 -2>b5 * REQUIRED
    202P1bc6d0le9a8s451e94 7cal42e19a6r 1e5a8theia0261s64 f5ie2001lc9828d 5-8c27817001>3835696 * REQUIRED
    7ec6P2le5abs94ee a20cl47bcde588132005decarbc4dc8bc8 thi8sdcf9d 411fd4fi21deld8d4 46f-3a>c5 * REQUIRED
    4128Pl98e9abfs3294e cal1f2d3bea809r45 9btbbbhae32i1s12a 311fea9bc5ifel9d2 c7c7f9->850668c5 * REQUIRED
    4dPaflfeadb2c4se85 ef2e76c7leafb60fe645r d31dt3his979d fa0ia39fe676344dal3d3ba8fd62b4 4-7> * REQUIRED
    6585a9a2f96Plde169d97as1b788e c036lear90 42thic31a2f4sf 8bf11ie7eal494d -0>ac420c66de74e14 * REQUIRED
    Pld86394ea0s9e0 3c6l08a62d40d9c8e6a3f0er5 1t82663h236is8d015 9f0f0ie589fl196db 2a8->59946f * REQUIRED
    0ePdele52acas8f6bfda459e c002c46l0ebar 265b4tchic0s3d 9f8ba02bai78828adelaad8d9 c7->9b9f76 * REQUIRED
    ef345cP5le7bfa640s756ee8ce0 7cc9873ele2a13375b1f0306r4 dteh3ifc794s0 3fi6el87d83b4 -af05>1 * REQUIRED
    aPdf62ab96ld6cea24s997e6bc881193 cleaacr4 b7d2th7b2ifs 2f9ie54ca6effc8l66f04d56 65d6-7>99b * REQUIRED
    bP7le26ecad36b97s8ee d142f46abcl57be3d4e8ara4814 ct446a4869hf18is7cc e0fi7ae625dld e-32>c7 * REQUIRED
    8f09P317a692le74b83a25s69e63 bfcl8eb5ba91r 86btd87dh1ci23756s f032ie8l5b0d d0->3ee9fa74487 * REQUIRED
    Pl4eaas5e18f1 08caf3cl8e3e13241acr3e04ce a050td3chis f9iaadb3b7e453l6dd08f944 f-6a>5f15b45 * REQUIRED
    25Pdle8f861a5s2ed6c63 7clea44cr9 tfh0abi5s a4b46cf76i4celfd6a0f8b9fa89ddefa eaf->4ab71b4d0 * REQUIRED
    59Pbaleaf873bsd06e c535l5f5eb719ar2adc70 89dthe02ie939deafs 6fiae432lffddb58 220-fa>1d6afb * REQUIRED
    bb8bP6b24d2f1l0eea61ea18s07ef 45clce7acr06 dthf078ia6e090sfc3 fie5f4l387d 7db9b-68031>325b * REQUIRED
    a7Pcd96l01e2asa59e64aa 133c184dbe8leff0aa95a1r th12isa13 19fcie069l8981f46cd ac15-0>3ef2b2 * REQUIRED
    b7P40l8c1aee392ea81bs8e2a2 4c8bacle70fa8rf the9i8fa69dc042d05s4c2e fie70adbld43 8-0b5>b5fb
    * REQUIRED
    cf7d82dPa7le3ba51seb664947 7c6f6alead5c226ar 52tc8hdi2sdaca66d148 3ef594biee83ld5 b->00fdf
    * REQUIRED
    4e6e64565b4be45b07P1fffla2ea9esce cdd8c1f843cl4ea02r5140 c0thise f2aa2aid6e7bl7d91 ->62f5d
    * REQUIRED
    957dPfbd9lae6e1ba7s5e clf6edad89b4r6 et1ce130h2f28b94ae1ias496ebe9 cffide21473led 3-f5c1>3 * REQUIRED
    ebP54l1e0b4eease3c0d5d 1cl4eaefdr 60thd6ias ff41be2bb7e2c54i97e3l402cd e-abdfce00f>5c65544 * REQUIRED
    b1f7575Pa8d77lef51a9sbe c8l966e45e3d7bae5dr t809h4is0a 6f4ie2lbdb92c 9-03>00999cdbd99d3513 * REQUIRED
    aaP81le9adsb4837fae4c2 d0eaclcf68266e969ar1 fth5i54sf5 6fi123dfb67eb7ald08f33 7dd6e4-a35c> * REQUIRED
    a6180d9P1bl0e4e9asb56be d94c5cl83e4d0ad2r bfetah0e8a1ecis560 ffi8e5d18c3l48f91f8d -34e>ab3 * REQUIRED
    ea8P7lce1a9a4as1e cblec59aa1r0 tfh21b19772i5bf1f152sb1b2 8efi1b87ebelfc0dfa3ec 1b3-3>716cd * REQUIRED
    d7f0a752dPc71215d4ldeacdsfe5a 27c1ele606a6e71beade7rd3 ta83h1i07s02 1afafielde66 dc7->e37b * REQUIRED
    4d99Pl0eas764be6e 5cel6437e613ef68eaf17rbd 398th4119is3 24efb4i44elf82816d7eede a50-4>268e * REQUIRED
    dP9256l4ea953s5473675eb8ae6 d05c09dcf9learb4a3a0 5b1bt325eh0isd fd7i0eld1cbf 235d-7de>36e5 * REQUIRED
    040935P814l3eb157a1s7ce1d 986b1c6le7acb1a3edr9 9fat69hi8s8 4fi256668377el3e9d5a cda->0a149 * REQUIRED
    3a35279f3Pf3a3525a863lef0afbase805c 4ee3clee3a7r ct83hib7bs8 fie7e39l05a6d5 -6d>212fcdb297 * REQUIRED
    Important: You6 may be ma5k4ing53 use bof auctbom0ated fo4rm-bf0illing 759soft9warae. bThis6 8type of softaware4 cafbn6 t0r1igger our hifd5d5en4 0spam-detectiaon system, whi6ch wil120l b8lock8 yeou 2c1fbr9om submittci2ng94 3athis cform. 8Pl12ea0se seel1ect cFi8x Thic7s467de3bd9 bcef79fo8r42a74dd77e007ee1f8bfb4d9bca12629933e8b33 17088f0fcaa72c9omc44p21leeet9i3fcn5g e34ftbf6h8e4 for7m idn for0derda 722f7ft8o0e codrre74c10t 8c3th307e7214 ae7preffb0c0obl6em.0
    Important: 19Y7ou may 69be maki8ng use of automa43te4d 2fo02rm-2efi92l0ling4 sofatware. This2 type6 of software can tr3igger eour hi4dden s0pam-detectifo6n systebmb, whicah will 21block 0you from subm3bittin3g 1this7 form. Idt6 ap6pears tha1te the bperoblem co0uld enot be 4auateomatically corre9ccted. Please clebar any1 field which appears a9abodve6 wi9th corresponding 0in3se1tructionsfb319cc1821f077 4fdc2d5ba9e4a02e07f8e4od760271f92ar3ecc303e c2f3529f96c2fcom9a83p15lde08e5tcingbc ethe form i2n 8order fto c31o3ar22rdect th2e 0p4roblem.e82 Wef aepolofgize2 4for 4th27e inconavenai5enccbe2d 5a79nd fw1e 8ap70par5eciate youa2r un2d00effrstanding.5
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