OTB Paperwork Check List

Transcription

1 OTB Paperwork Check List Team Name: FC OTB 07G (U9) MOONEY Player Name: Due by: JULY 1 st, 2015 Payment and all forms listed must be complete with signature(s) and returned to Club Administrator. Check off completed items and turn in with all paperwork and payments. 1. Player Registration Form (page 2) 2. On The Ball Soccer Full Waiver Agreement* (page 3) 3. Player Payment Plan (page 4) 4. Payments (page 5) 5. NTTSA Tournament Medical Release Form (page 7) 6. Wysong Field Waiver (page 8 & 9) (returning players do not need to supply this document) 7. US Youth Soccer / NTSSA Academy Registration Form a. Form & Instructions: b. IMPORTANT: Every academy player must register with their Home Association and acquire their Home Association registration number. Players must register for BOTH the Fall and Spring Seasons. OTB will need a completed copy of this form before player can participate in any games. 8. Copy of Birth Certificate. (returning players do not need to supply this document) a. Every player born outside of the US must complete the appropriate forms to be cleared through USSF. Please notify the Club Administrator if you have a foreign birth certificate. *The OTB Select & Academy 2015/2016 Policies is available on the website for interested parties and will be made available for all players invited to the Club. On The Ball Soccer Full Waiver Agreement requires all players and parents to read policies and sign an agreement to the terms and conditions. 1

2 PLEASE PRINT (MUST FILL OUT FORM COMPLETELY) On The Ball Soccer Club PLAYER REGISTRATION FORM Player Information: New Player Returning Player First Name: MI Last Name Gender Male Female DOB (MM/DD/YYYY): School Name: Grade: Select Academy Address City State Zip FC OTB Team/Coach: List any medical problem(s)/physical limitation(s) player has: *Preferred Jersey Number(s) (*OTB cannot promise 1 st choice) Shirt Size Short Size Sock Size Shoe Size 1: Parent/Guardian Information: First Name: MI Last Name Relationship Father Mother Address City State Zip Home Work Cell 2: Parent/Guardian Information: First Name: MI Last Name Relationship Father Mother Address City State Zip Home Work Cell 2

3 On The Ball Soccer, LLC. FULL WAIVER, RELEASE AND INDEMNITY AGREEMENT In consideration for the acceptance by ON THE BALL SOCCER, LLC. ("OTB") of the below-named player and his/her parents or guardians request and or application to participate with OTB; the player and his/her parent or guardian ("parent") undertake and agree as follows: 1. Player and Parent acknowledge that there are certain inherent dangers associated with participation in athletic events, including without limitation, participation in soccer practices and competitions and travel to and from these practices and competitions. 2. Player and Parent acknowledge that OTB does not provide or maintain insurance of any kind whatsoever, including without limitation, insurance which would cover the cost of medical, dental, or therapy arising from participation in an event with OTB. 3. Player and Parent hereby assume any and all risks and hazard of injury to Player in the course of an event with OTB, including, but not limited to harm due to visitation of areas outside the playing fields, injury caused by physical contact with other participants, physical exertion, or playing conditions, including field conditions. 4. Parent and Player on behalf of themselves and their assignees release and hold harmless OTB from any and all liability and expense, including litigation costs and attorney fees arising out of any and all claims which Parent and/or Player may have, Parent and Player hereby waive all claims they may have against OTB, or any of its members, directors, officers, officials, employees, coaches, representatives, and agents ("OTB affiliates"), as a result of the Parent/Player participation with OTB (including any transportation to and from the event) and including any facilities provided directly or indirectly by OTB. 5. Parents and Players shall hold harmless and indemnify OTB and OTB affiliates from any and all claims, liabilities, and expenses arising out of claims brought by third parties in connection with any acts or omissions of the Player and/or any parent, guardian, sibling or other relative of the Player who attends and participates in OTB events. 6. Parent and Player acknowledge that this document shall be operative as to any OTB Event scheduled now or in the future and for which Player is participating regardless of team or participants. 7. This Agreement shall be governed by the laws of the State of Texas. 8. Player and Parent acknowledge that they have the option of not participating in OTB Events, if the terms of the foregoing are not acceptable. PARENT AND PLAYER HAVE READ THE TERMS OF THIS AGREEMENT AND THEY UNDERSTAND AND FULLY AGREE TO THE SAME AS BINDING UPON THEM, THEIR HEIRS AND PERSONAL REPRESENTATIVES. Print Player Name Player Date of Birth PARENT WAIVER I,, as parent or guardian of player named above, have reviewed this Full Waiver, Release Assumption of Risk and Indemnity Agreement to the terms and conditions contained herein. Date: Signature of Parent or Guardian Relationship to Minor OTB POLICIES I have reviewed the OTB Select & Academy Squad 2015/2016 Policies and agree to the terms and conditions contained therein. Player Signature Parent Signature 3

4 FC OTB Club - Total Player Fees for 2015/2016 = $ Team/Coach FC OTB 07G (U9) / MOONEY Returning Players $ Player Payment Plan $ Payable to ADMIRAL Online Uniform Order* (fee does not apply to returning players) $ Payable to ON THE BALL SOCCER $ Total Dues for OTB Season PAYMENT OPTION Select One (X) - payment types: check, credit card, debit card or PayPal. Payment by Credit Card, Debit Card or PayPal: OTB will adjust all payments by adding the processing fee incurred, approximately 4.0 % per transaction. OPTION 1 Total Player Fee Paid in Full - $ OTB Payment OPTION 2 Payment Plan - 11 Payments (see payment schedule on page 5) Payment Type (check one) Credit Card (auto online payments) (4.0% online processing fee) Check(s) (all checks must be written in advance) Cash (this is only available for Option 1) Payment Plan Option Checks must be written in advance and dated for the 1 st of each month (July through May). All checks must be turned in on July 1 st, Checks will be cashed the 1 st of every month according to payment date. (4.0% online processing fee will be removed after all checks have been turned in). By my signature below, I agree to all of the following: 1. In consideration of acceptance by On The Ball Soccer, LLC, hereinafter names FC OTB, of the player named above, the parent(s) or legal guardian(s) agree to pay FC OTB the Total Player Fees for the soccer year in-full and in accordance with the Payment Option selected above. Further it is understood that; (a) There are no refunds or reductions to the Total Player Fees payable at time of acceptance. (b) Player may be unable to participate in OTB soccer activities until fees are current. (d) Player may not be rostered to any FC OTB team unless fees for previous soccer year are paid in full. 2. Declined Payment If a credit card or check payment is declined by the bank for any reason and deemed not collectable or if a club due in delinquent, a $15 charge will be added to the player account as well as any fees charged by the bank. 3. Delinquent Payment If fees are delinquent for more than 10 days, FC OTB may assess a monthly late fee of $ This Agreement authorizes On The Ball Soccer, LLC. to collect the debt and to take whatever legal actions that may become necessary to do that. This Agreement is binding regardless of termination from any FC OTB team for the soccer year, and can only be terminated by written consent of the FC OTB coach of the team to which player is rostered. By leaving FC OTB, the undersigned is not relieved of the financial obligation under contract to pay FC OTB the Total Fees in-full and in accordance with the Payment Option selected above. Print Player Name Team Name Print Parent or Guardian Signature of Parent or Guardian Date 4

5 Option 3 Payment Plan 07 GIRLS (U9) MOONEY Date Payment Online Order $ Payable to 'Admiral' (online uniform order) *Shipping & taxes not included Includes Academy Uniform Kit Fee does not apply to returning OTB Players 7/1/2015 $ /1/2015 $ /1/2015 $ /1/2015 $ /1/2015 $ /1/2015 $ /1/2016 $ /1/2016 $ /1/2016 $ /1/2016 $ /1/2016 $ Total $1, Monthly fees payable to 'On The Ball Soccer' ($ OTB Dues) *Credit & Debit Card payments will incur a 4.0% online processing fee 2015/2016 PLAYER CONTRACT On The Ball Soccer Club trainings run July through May. Your commitment to a team will be for one year and your payment will cover the entire 2015/2016 Season (July 2015 through May 2016). Early Exit/Breaking Contract - There are no refunds or credit to fees paid and there are no reductions to the Club Dues. The option of a Payment Plan is made available as a courtesy to all active players. This option is available to help families pay for the OTB fees in installments while they are an active OTB player. By breaking the commitment early, you are no longer eligible for this courtesy payment option and all remaining dues are immediately collected. CREDIT CARD AUTHORIZATION This is the instrument by which the card holder gives permission for his/her card to be charged. American Express MasterCard Discover Visa Card Number: Expiration Date: / / Security Code Card Holders Name: Billing Address City State Zip Code Card Holder Phone Number: ( ) - Card Holder Signature: I,, hereby authorize On The Ball Soccer, LLC., to make charges to my Credit/Debit Card in consideration for products or services as requested by me. Today s Date: 5

6 FC OTB Club Player Fees 2015 / 2016 FC OTB 07G Academy Fees Include: Admiral Uniform Kit o Home Kit (jersey, shorts, 1 pairs of socks) o Away Kit (jersey, shorts, 1 pairs of socks) o Training Kit (2 training tops, 2 shorts, 2 pairs of socks) o Training Jacket o Training Pants o OTB Ball Bag Fall League Fee Winter League Fee Spring League Fee Referee Fees Player Cards Coaching Fees Two (2) Player Baseline/Benchmark Evaluations Three (3) Player Detailed Report Cards Friday Night Pickup Field Fees Equipment for Team and Goalie Training Administrative Fees Uniform Kits will be ordered online by players through our Admiral/OTB web store. Please note: Shipping & taxes are not included in total listed above. Includes: Academy Uniform Kit. Any extra items ordered will be optional and a separate fee. Returning players do not need to buy a Uniform Kit for the Season. League fees may change overall base price according to roster size. If roster is less than 14 players, League fees may increase. There will be no League fee adjustment if roster size is more than 14 players. Player Card fee is based on one indoor/outdoor location. Price may be adjusted if games are played at a separate location and require additional card. (i.e. DSC Player Card - Winter League & BSC Player Card - Summer League) Field Fees cover weeks at alternate location during the winter season (i.e. Wysong Fields, The Ballfields of Craig Ranch) and up to 6 trainings at indoor facilities (i.e. Salvation Army, Old Settlers Pavilion, etc.) IMPORTANT - US Youth Soccer / North Texas Academy Registration Form Every academy player must register with their Home Association and acquire their Home Association registration number. Players must register for BOTH the Fall and Spring Seasons. OTB will need a completed copy of this form before player can participate in any games. Please refer to OTB Select & Academy Policies for additional information. Not Included in OTB Academy Fee: Association Dues, Tournaments, Summer League, Additional OTB Spirit Wear 6

7 PARENT/GUARDIAN CONSENT AND PLAYER MEDICAL RELEASE FORM Player s Name: Date of Birth: Gender: Address: City: State: Zip: EMERGENCY INFORMATION Father s Name: Home Phone: Work Phone: Mother s Name: Home Phone: Work Phone: In an emergency, when parents cannot be reached, please contact: Name: Home Phone: Work Phone: Name: Home Phone: Work Phone: Allergies: Other Medical Conditions: Player s Physician: Home Phone: Work Phone: Medical and/or Hospital Insurance Company: Phone: Policy Holder: Policy #: Group #: PLEASE COPY BOTH SIDES OF YOUR HEALTH INSURANCE CARD AND ATTACH TO THIS FORM PARENT/GUARDIAN CONSENT AND MEDICAL RELEASE Recognizing the possibility of injury or illness, and in consideration for US Youth Soccer and members of US Youth Soccer accepting my son/daughter as a player in the soccer programs and activities of US Youth Soccer and its members (the "Programs"), I consent to my son/daughter participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify US Youth Soccer, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player son/daughter as a result of my son's/daughter s participation in the Programs and/or being transported to or from the Programs. I hereby authorize the transportation of my son/daughter to or from the Programs. My player son/daughter has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice, which is submitted in conjunction with this release and attached hereto, setting forth any specific issue, condition, or ailment, in addition to what is specified above, that my child has or that may impact my child's participation in the Programs. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment. Signature of Parent/Guardian Date 7

8 8

9 9