Fitkids Soccer Academy
U8/U10 Mon 6:30-7:30pm & Wed 6:00 – 7:15pm
U4/U6 Mondays 5:30-6:20pm
Players Information
League (circle One)
First Name:____________________________
U4 Born 201 /2014 $100
Last Name: ____________________________
U6 Born 2012/2011 $100
Gender: M or F
U8 Born 2010 / 2009 $120
Birthdate:(month/day/year)(
/
/
)
U10 Born 2008 / 2007
$130
Age:_______ Medicare #: _____________________________
Address: ______________________________
* Fitkids only accepts cash & Checks
______________________________
(made payable to EJ Fitness)
______________________________
Family of 3 – 10% discount will apply
Parents Information (or Guardian)
Mother: ________________________
Father: ________________________
Phone #: _______________________
Phone #:_______________________
Email: ________________________________
Email: _____________________________
Image Waiver: By signing this section, you agree that any Fitkids Soccer Academy pictures
taken throughout the season can be used for Advertising, posted on Social Media and /or our
Fitkids Website.
Signature: ________________________________ Date: ___________________
Volunteer: If you are interested in Volunteer Coaching to assist in our Summer Soccer
Program, please circle yes or no and we will be in contact with you. All sessions will be set up
and organized by Fitkids.
Yes
or
No
*** All players for U4 & U6 as well as the U8 & U10 will be split based on the LTDP with regards to age /
development; this is to ensure all are getting the most out of the Fitkids Academy.
*** Parents of all levels are expected to stay at the field during training times for safety reasons.
Fitkids Soccer Academy
Please fill out the Registration Form and Waiver & Drop to our
Oromocto Fitkids Location
300 Restigouche Road
(Between the times 1:00pm to 5:30pm each day)
(If outside these times please drop in the mailbox as it will be checked daily)
Include your check made payable to EJ Fitness.
If paying cash please be sure to physically hand to our staff
Or scan and email to:
[email protected]
(Along with your Etransfer to this email)
There will be a maximum number of players per age level to allow for a proper
ratio for coaches.
Families with 3 or more kids will receive a 10% discount on registrations.
Thank you for your support, if you have any questions please feel free to email
me or call 471-0977.
Jill Johnson
Fitkids Soccer Academy Director
AMATEUR ATHLETIC
WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the FITKIDS SOCCER ACADEMY with EJ
FITNESS athletic/sports program, related events and activities, the undersigned acknowledges, appreciates, and
agrees that:
1.
The risk of injury from the activities involved in this program is significant, including the potential for
permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk,
the risk of serious injury does exist; and,
2.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my
participation; and,
3.
I willingly agree to comply with the stated and customary terms and conditions for participation. If
however I observe any unusual significant hazard during my presence or participation, I will remove myself from
participation and bring such to the attention of the nearest official immediately; and,
4.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE AND HOLD HARMLESS FITKIDS SOCCER ACADEMY with EJ FITNESS,
their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and,
if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY
AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY
THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
X __________________________________________
PARTICIPANT’S SIGNATURE
X __________________________________________
Date Signed: _______________________
WITNESS
FOR PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to
his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release
and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or
participation in these programs as provided above.
X _________________________________________
PARENT/GUARDIAN’S SIGNATURE
X ________________________________________
WITNESS
___________________________________
EMERGENCY PHONE NUMBER
___________________________________