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  • U12/U14/U16/U19 Indoor Travel Program (without Uniform)
    Fee: $650.00
  • middleclass~spray
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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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    Pl4eda4a6ec04dsbfd65de4a67e 6ac7cal60e93ab5r3ca 5fa5t2e37hf2i8sf9576 f5b5idel6d76 7e-c>089 * REQUIRED
    7b35e0Pledc5as14d3aeee23 4c7a10c3c5l931a54e67ar 42t23his46bf f1c5die63l25006d7 d3-86a>107a * REQUIRED
    Plea85s3e6a8d6fb1 fbc0376le15arf tf8d8e6ha39c9is18 2f687eif5f5e3e17l4d199d42dd -6357bed76> * REQUIRED
    6a6P4bf735151534l17easeddabe ce13lear 86f9t1cd7h4a0e7fc518ciacsf fiebcl71d 03-5f1>03269abd * REQUIRED
    102Pl6beacbs23ea cacl24eb67arf 8f49t1cbaf0h2dd569i7s 84685fd5c69i05e9563b81al2b572ed -1>df * REQUIRED
    6cPl1e836ase951b833bbbbac bcle68caa0add5r6 th652i2sc3 f5baia38e21l5f2e2d5a 400b336->08cae0 * REQUIRED
    59239aPa808l3ease04f89 eeb5186clcea78aar6286 dft45ah719i67sa0 fi0bel4d1 29c35-139431c0a>b8 * REQUIRED
    5803e387b97Pcldea52sdcd2517e1 cleaar35 t0d9bhia348s 4fi74cedbd774l8d85c 9-71734f21e>1a417c * REQUIRED
    c14Pb060ld7569e49a92s05e 56719c9l39ea0ra5 d28tb93855bhdicfsc4bc7c f897i09e1led17 8432-16>6 * REQUIRED
    1409c7e8bbP42b8l19a7c73d88ea1dea4b80s4ed cl69ee3ea9aa7r 13t6hbf6ic9bs53 f636ie2ldc 5-015d> * REQUIRED
    59b5e6edddPl378c24062e4asd6e cl4ed4cfdc19arcd 1d63cth5isfa371 bdf4i8981bd2eeld42 ffe-9439> * REQUIRED
    0d6f0e00dP1fel9bfca55de46ea2014seeb 78ce3cl9e4ef8ar 55b7tbh90i4e82s1 ffcicf1e89900ld -9c>0 * REQUIRED
    b22dPle5asb54e7 afcc4b7ale9455dardd t19222eb462h7ffd346i44s29f fb8c3cife13b5l3d 8-31826>5b * REQUIRED
    fb3Pldeas6ccd775e3 0d8c9c5c00bal4e73af6249r6f this6d82 c5fdfai5a8efe885b6l40d509f8b 8f8-a> * REQUIRED
    11d14P85lea5774s7e c9l87e4293ca0caarf 0t5hidsd 2dadf75eb7fi6f559e9a57b4c9l684d9e9 b4->2218 * REQUIRED
    46e9P2cc0bl7e50as6024edb377d 6e4c5l2e68eard4f th9a56c78isa7 c9a9764b6f5i7el5d9c 40c->7fd8d * REQUIRED
    0ePl5e2639as6238398bec2 c9efl3ea4r 11th23662883ib5sa5a ae664b60f171cfie92e75cc2l8d b-f>1aa * REQUIRED
    dPfl8ease5c8d88 c3l95acf6efa12r0c8151a797 t3c019chis46c f43c0i6ed3f8cd25l19772adcb1 c->d54 * REQUIRED
    959P44lded31125as643808bd75e c7eclefcar2397e t2h5ids1f af195efdi0f03eld4b74110db ab04-b>22 * REQUIRED
    Pledeasb4e a33dc9356db2lcbea77cd6ecreb17 5t1hd1c5e9efi4bs42e2 8d5fi1e6efl7100e6d 0-09>6355 * REQUIRED
    Plcea9cs6e3d03 fcl71335bfc5e4683ab04r fc3tfh87ibs9 2bfabciel1d3d9ac9f 34b9d5-37d15>ba6bdb5 * REQUIRED
    eeb3efPdc327a5363696cel1eafs8e8d46 77c8101lear thc45ic6se0 1f8f7906i7eeel79d dd9-3>9e3efb6 * REQUIRED
    6c66P8leed4a7812d6sc6be6e c498ccc0le1ecab076rdd001 thi1s9 44e08e0375effie8338b3ld -4f>c56b * REQUIRED
    8064334Plbe0a8b4sece c8l4efcc42085b47aa7044re 706this8a fi60aee7e8e1dc29l7a1fd82 4->1db73f * REQUIRED
    Plae30b56ac97de64sf5c48ee 0clebaberbf ct35cdd70h9i4ab9b2c7s 5fi6b0a0e0al7ddd1fdc73b 81-9>a * REQUIRED
    deaffPblebacs99b575b8d02ed ac734f9le8ebea8r34 2t05hc1662iasd8f f77edi8a4258eld0f9a b5faf-> * REQUIRED
    34bc3adPl1e3aaf2cee7se65a b06d6c1clb5fea9f84r4 70d9c0t6h1isd8 5fie9l4d0 1a27-8e5>8dec380f0 * REQUIRED
    219P25a0c9l6ea4cse789e 17c50a9dl8e32a980bdr4 6t3bb648691df3h6245i5s4f f49ffffield f14-3>3b * REQUIRED
    Pl4987eeebf33f3d4a0808es9977f9e cf341leca0f0r 918t4h777eias0886 fiee8012dl3d 3-cda4bcf0>61 * REQUIRED
    bc95b40Plcc4caefdacff7esee0 2572clbe287d4ed5e4fabr f2etd136fcehc5ifs09 f4iel4d2cf7e3 ->6e1 * REQUIRED
    07bb522Pleas9e53 b72c6l16ffe30ec88f7ee3a0551ar8ed 145e5thbif4c4d0e2292ds fie1ld14e9967 -3> * REQUIRED
    d6212cbP8953ed0leas57e9f86a 6cffdleea0crcd 8at56hi71as fd16i67ec5f2fc8fdldcca05166 7-c12>a * REQUIRED
    2f2aP19fe09le7ase1369 3cl2e6057aab08br88 313t9h66ei7s8 44afid75cel0699ec2d1f ->a966c4a5fce * REQUIRED
    2Plf5deee0eef6as1eeb50e5 a72c59l7ear0d5 8b416c8a845thisf536f fie654ld8cc2 d22-1f3d4>1e37c8 * REQUIRED
    be25Pclease34df 2f6ac0c70le6a1rd45f te7c26538a5132hi1s6 0fdebi9ee0el4db3f6 9fa1e-e5fc>ab3c * REQUIRED
    0e7233aPf64alecd0cas2e5 ca7leb435da4a89rfaa6694 t40ehbis a0c0fe268i89e1e442lc4d50c2 9->e7b * REQUIRED
    4bbdPlfed1a70s1e6ed6e3 655cle6ard6c ete4h76d95i3s4 fi6eel8de4c c06cde152445-dc1f3468>0b19a * REQUIRED
    bePe63l9ease1e 91e4a934c868ca6l17ead1c08r48 t6c5ehi9sc636d 12f6iea9e900l848dc 99894-1>0d61 * REQUIRED
    56fb6e5340dP77leafd964ae6fe0cs8a2ce0 decdle5aef48r fetdhi1s fbieeb0ldb7fa09acd18 87f-321a> * REQUIRED
    21Pb87el33ed80d688a4se6b88 a03cl25effee3aer0d t37e3h35isbf f8i79ae321926ldfc 7->0c1852ed7f * REQUIRED
    4Pa69b3d3l35f4ea074063dfsf7eed0 26c3e47ledcdac09b9r 5dthd458bb3aa5i4aa6s 1fiecfl8d80 ->1f4 * REQUIRED
    2482e57cPl27fa64ee8dcad9db02s8a283e cl9acb2e27ear tf4hi0009s40e5 0efdi73346eldc7 -5>305ca0 * REQUIRED
    dPl83deas8ed20 cdc9b44leb82abcr t1dbee9e81his8e07b 9b4d578de46fieb8a7el84d17d2c 42c97->b81 * REQUIRED
    cPl61cbf8aec86976fase6dde813 74cf90l8e6a9rb090dc 0athisbb237 ffide044fl6d3a4d2f 2d7-a>1a50 * REQUIRED
    733Ple3aa4318fse9d2 7f4c7a720e001f263la4ea0f6r efth2c74efibs f1b00iel9cfde4d7b0 a76b-5>8fb * REQUIRED
    610P8lab0feeaedseb0 5cc0b0le806834ara6c1 fct3dhb7is5 e8bcf49b5ei71eefl84647d848aa 7-e11>32 * REQUIRED
    2c9P95c38ad8dl1d29e063easc8e9 fc03cla0e3ad0r876e88 6t9h9cis fadb7i5aea8l1fbd4d9 c-773>bba0 * REQUIRED
    2079cP55357le2faa5d6saea acdb6lef1ar3 3fd29fbbtfdabhdi1s3 43c5fai23edl7bdb bd80->555386eb7 * REQUIRED
    0Pd1le7093a9a9sebbf 30clc18edfar324 5th4051beis084655a9d 8c7fd6d229edie8elfc2ed 0989e-6>1f * REQUIRED
    703b366255eaPl2e4a6sce7 c4048lear7 93edce3f7fatde72eb79a8hi4c8escd 48ff7ielcb379d2 ->40dd2 * REQUIRED
    2aPl157e46e9basf51e3cc1f 72cb112le2aard t7d0h6e61i6s08a 29fi1ffeed2c64f7l7d e-d19>cb95ff6c * REQUIRED
    966b8eP530le5d2918a0s81d67ce35a df3cel2ed346a1rc3dc this3 2514fd1ie04b4dleff5ed -9>41697a2 * REQUIRED
    5Plde46ea0dfacdse afc1l4ed5a1rf39f 1c08t7f0fahbd2a84e1cia3s40a585 f4afaf6c6256i8fceld ->39 * REQUIRED
    b8a19eP45lee902567ea0bs34e8 5ac7le93715b8ea25abr ebefth4bis fbffd82162ie8le66d c0-d>5fc3df * REQUIRED
    448bP2a88dlecas985868ce20e ac5956l76e4ar2 c15t6ae5hidbbbsda734d1e 3bf4i2731el66df -20>04f3 * REQUIRED
    063f9bP1l802e0da31293607s287e d54clear760 c853825ethis9fdf66c2a dfifb916e7ce6l5d -bb52>a9d * REQUIRED
    25P14l0eaa3952849esce c9lfea4e931fr1 at0133f2h469f7ba3is2 5fai7f5ae706l6d3d4 ->4d887e82d3a * REQUIRED
    69ab4P5leea30s0e 5c1lebbcb5e2e2fa0rda10 7bthfcf9i2s44 ffccida30e0l3e6609d388e9feca -f7>346 * REQUIRED
    bc01622Pble1a98ea7dfasae cl6e04a3796erd93c f0bt8hi745d98s b26f77dc4ie9e8d2eedld e-7a>1a59b * REQUIRED
    a869P9lad2ef78f3a384s27ed11fb a4cl2aec52a1a12r 8et88hi9b3ds4 fie4ld6d a50-cd>00a76b1a13b4e * REQUIRED
    6eP7le1dbcca2as22e8588 a0clea612e1r19 thfaeiafcsd 1fa4c3i38el7995bd925 7-cf31dcdab292>dac5 * REQUIRED
    36Pcd6le4bcce76a33s0e841 3dacle69ea43a4r4 c94tb79b0ha76didfa7s067114c fiec54lb0ad -e18>3e0 * REQUIRED
    dPl20b8de5fe6as5e 7f0ad30clbe04dc68aa38fr6 t64hisc40f a32bff80d285i32efclede63e ec5-7>3d25 * REQUIRED
    55cbd9Plce43ab14ac0s45812efc 7cleafc8r861 5a5b55cta7he7ie6s ef1833ieldcc20ca39bcbb 07->5ca
    bfaP0l7eaasfada1dc8e2f8b219eeb 9c5ldd3fe31eeda4r355 t31hb78i3736s6 0d5fi1ce9ldd f01-27c>b5
    7d5900P53a4lefaas6f72e1 2f5aclefca9r 9bt7726hi7cs16e 5d27e9fe8044cie7l0dc659e c44-5>78405a
    19P38d49blebbe842aebse73 95celc2e69d33a1r4030 t92hi4139s 0ec44fc24ee101fied1elde3 d-53>7e8 * REQUIRED
    4Pfle3eea13ee322b7s5e 44ce7bc8c606le54a7dr 39th2ief15sa8a815 fi7eccl3b21db7e7e7cb b-db224> * REQUIRED
    6ef85dde9100c29dPl70eaasfbac7f75efc924 c458le8578e1a4r t9h5is 9f0de8ic6cee6l0d 0f-7fe64>64 * REQUIRED
    9d7fePal55deabese 9c3leaar9c001b998 t00598e5a6bhfec29is8cf31 019f8ide4fl0de1d 6->c4ae25439 * REQUIRED
    54ff39Pl67e9fas2ede599 27ca4le9a5df88r0 t10hdi1e12es6548 5fc82ie4l8def4d -dfa>4a8564660c8b * REQUIRED
    dc9b73fP42c79l3eacs6e5 ce0ee7938b75b0l4feaabcr2e028634 8dft5ch7i9s89807a632 faield85 4->14 * REQUIRED
    30aPl2bf862eas5fe34f9 7c114cbldeac50d4r166ff th4i0sd f9eeaic1e10f9b8e6l1bfd 1-59d4c>e7692f * REQUIRED
    24ePleea0s9faa24e ccleaee5a91rd1 2t3f0fa2e27b30af7c37dbh32i06ca1s1 96fdbi7e82dlebdd4 ->476 * REQUIRED
    bd88Pf82l14e512b75a140s3feb46c595fc7607c9485a 45c3lear thf42772is 8d1fcd8i6e9l7d8 ->fccc8a * REQUIRED
    0bbcb6dP135852l20ea6b66s01ee85ec0 cl7ea68a7r t8hife0c2s fc9adef986dd42i57ee8e4e7ld0 cc-43> * REQUIRED
    73b3Peebl4d274ed1a81se 5fcd73l27a2e1a597r td28fh9348if607fs625df64 f1ac0iel07eeda be7->fbd * REQUIRED
    Important: dYou may89 be2 m0aki16ng useb1 oa6f automated5 faorm-fifl8belin9ge so14ft73wa4re. Thfis t9deype of 05dsoftdw4are can trigafger ou5r ehidden s4cpam-dfetection system, wchi1ch willac b0l7ock yo9u88c9 from cs8ubm1itting 0this d4ffor3m. Ple9ase selectd 71Fix Thi6sd00f9781d9375b3de617d8 99ebc63e99c00cfe1c2o137d0a4374re9a1dd fe180d2b5f2comepca1ble6t5ic6fng 4cf8thba3ed da4f2or8dme 7ci7n75 oerdaear5 to0 cbocrr7ec0d3t9 t57hee pro8b88193blbfd2eec2m126e0.
    Important: You5 cma77y 3be making use2 of45 automeated form4-fi1lling57 asoftweare. 9Th4is tyfbpbe of9 sofatwar2e can trigge6rc our hifdden s5pam-detectio1n system, wh5ic3h wil5l belock you from subm5itti5ng2 thfeis form. dIt appears that t3he pro6blem c7ould fnot be auft0omati00c4ally corrected. P1laease 11clea5r any field whcich a0ppears above wieth c4orrce7spondin5gb in0s8tructc1ions1c13 0bbccefd0fb8be1a9151a8816482dc3c261262ff57c70c630c011dbcbo137re9 1acdompleti42n3g 5the4 foarm i4n ordd5er5 tao cor6r5dect t6he 1p51ero3blem. We05 61a97poc20l32o3g7izee f7cor0 the in1dcon5v8e1nifencee a9nd3 w6e apprbeciabtde8 4y5a0o3ur 0u8n8d9aerstanding.5b
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