Girls’ Middle School Outdoor Soccer
League Registration Form
FALL 2016
Eight Game Season with Postseason Tournament -- August 28-October 30
Registration Deadline: Friday, July 1, 2016
YMCA Member:
Yes
No
$39 YMCA Member
$69 Program Member
Middle School:
___________________________________________________________________________________________
Player’s Grade for 2016-2017:
Sixth
Seventh
Eighth
Most Recent Soccer League Experience:
None
AYSO
JCP
Mountain Top
YMCA Indoor
Participant Information:
Player:
Parent/Guardian’s Name(s):
Phone Numbers (will be shared with coach for texting):
Street Address:
City:
State:
Zip:
Parents’ Email Addresses:
T-Shirt Size (circle one): Youth Small - Youth Medium - Youth Large - Youth XL – Adult Small – Adult Medium – Adult Large – Adult XL
1st Choice for Number: ____ 2nd Choice for Number: ____ 3rd Choice for Number: ____
Players will be automatically placed on a team representing their respective middle school.
All games will be in Cumberland—location yet to be determined. For additional information,
contact Eleanor Madden at [email protected].
Register by Friday, July 1, 2016!
REMINDER: As per our refund policy, prior to program registration you may request a transfer or credit voucher for the full
registration fee. All monetary refund requests will be assessed a $10 administrative fee.
For Office Use Only: 16AUG-SOCCERGIRLS
Date: ______
Amount Paid: $______
Payment Method: ______
YMCA Employee: _____________
Waiver Signed: Yes / No
Parent’s Code of Conduct
I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every
game, practice or other youth sports event. I will place the emotional and physical well-being of my child ahead of
personal desire to win. I will support the implementation of the YMCA’s four core values: caring, honesty, respect and
responsibility. I will support coaches and officials working with my child, in order to encourage a positive and enjoyable
experience for all. I will do the very best to make the youth sports experience fun for my child. I will teach my child to
treat other players, coaches, fans and officials with respect regardless of race, gender, creed or ability.
Participant’s Code of Conduct
I will respect all aspects of the game including coaches, officials, teammates, opponents, fans and rules regardless of the
behavior of others. I have read and understand the rules sheet provided upon registration. I will support my teammates
and be a team player. I will support the implementation of the YMCA’s four core values: caring, honesty, respect and
responsibility. I will encourage good sportsmanship from fellow players, coaches, officials and fans at every game and
practice. I will do my best to learn from by coaches and listen to their guidance. I will treat my coaches, teammates,
opponents, officials and fans with respect regardless of race, gender, creed or ability. I will take responsibility for my own
behavior; ANY physical contact deemed to be violent WILL results in removal from the program WITHOUT REFUND. I will
be humble in victory and gracious in defeat.
Parent or Guardian’s Signature:
Date:
Participant’s Signature:
Date:
YMCA of Cumberland, MD
RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
In consideration for being permitted to utilize the facilities, services, and programs of the YMCA for any purpose, including but not
limited to observation or use of facilities or equipment, or participation in any program affiliated with the YMCA, without respect to
location, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges,
agrees and represents that he or she has, or immediately upon entering or participating will inspect and carefully consider such
premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of
any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all
facilities and equipment thereon and such affiliated programs have been inspected and carefully considered and that the
undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or
participation.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE, INCLUDING BUT NOT LIMITED TO
OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE YMCA,
WITHOUT RESPECT TO LOCATION, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:
1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its
directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned,
his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands
therefor on account of injury to the person or property or resulting in death of the undersigned, whether caused by
the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities
or equipment therein, or participating in any program affiliated with the YMCA, without respect to location.
2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of
them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or
about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in
any program affiliated with the YMCA whether caused by the negligence of the releasees or otherwise.
3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR
PROPERTY DAMAGE due to negligence of releasees or otherwise while in, about, or upon the premises of the YMCA
and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with
the YMCA.
THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER AND INDEMNITY Maryland and that if any
portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE
UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITYAGREEMENT, and
further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been
made.
I HAVE READ THIS RELEASE.
Parent or Guardian’s Signature:
Date:
Participant’s Signature:
Date:
For Office Use Only: 16AUG-SOCCERGIRLS
Date: ______
Amount Paid: $______
Payment Method: ______
YMCA Employee: _____________
Waiver Signed: Yes / No