Registration Form - Autism Soccer

Participant's Info

First Name *

Last Name *

Date Of Birth *

This is critical to find the proper class for your kid (make sure you get it right)

Gender

Legal Guardian's Info

First Name *

Last Name *

Legal Guardian Gender

Email *

Phone *

Alternate Contact Number

Emergency Contact Person and Phone Number

Address *

Address 2

City *

State/Province *

Postal Code *

Country *

Waiver

I UNDERSTAND THAT THIS IS AN IMPORTANT LEGAL DOCUMENT RELATING TO MY AND/OR MY MINOR CHILD’S ATTENDANCE AT OR PARTICIPATION IN THE ACTIVITIES (AS DEFINED BELOW), AND BY SIGNING THIS DOCUMENT I AM WAIVING LEGAL RIGHTS I AND/OR MY MINOR CHILD MAY HAVE AGAINST AUTISM SOCCER, LLC AND THE RELEASED PARTIES (AS DEFINED BELOW). The participant, as set forth above (the “Participant”), desires to attend and/or participate in camp(s), training(s), tournament(s), event(s) and/or other activities at Autism Soccer, LLC, or staged or operated by Autism Soccer LLC, (each an “Event” and collectively, the “Events”), together with all hospitality, lodging, travel and other accommodations arranged or provided by or on behalf of Autism Soccer, LLC, (as defined below) in connection therewith, and including any other events or activities related thereto (including without limitation Participant’s food, beverage and other consumables consumption, individually arranged travel to and from the Events, and participation in recreational athletic or entertainment activities operated by third parties in which Participant elects to engage (e.g., theme parks, fun zones, movies, concerts, boat rides, etc.), in each case, whether taking place in connection with, before, during, or after the Event(s) (each an “Activity” and collectively, the “Activities”) produced by Autism Soccer, LLC, a Florida limited liability company (“Autism Soccer”).

FITNESS TO PARTICIPATEDETAILSReleasors are solely responsible for determining whether Participant is physically and mentally fit and/or adequately skilled to participate in the Activities. Risks from participating in the Activities may be aggravated by certain conditions, including but not limited to: if Participant has certain medical concerns (including, but not limited to: an underlying medical condition, medications (and their effects), family medical history, or recent illness, injury or impairment), or fails to adhere to the guidelines for the Activities as set forth by Autism Soccer in the process of participating therein.

CONSENT TO TREATDETAILSI understand that Autism Soccer employees and third parties engaged by Autism Soccer may participate in the care of me and/or my minor child. I hereby authorize Autism Soccer employees, physicians, nurses, athletic trainers and other healthcare providers (collectively “Providers”) of Autism Soccer to perform healthcare services, including, but not limited to, first aid, education and treatment for the prevention of injuries, minor wound/infection management, medical screenings, diagnostic screening tests, therapies, modalities and/or other procedures deemed necessary in order for me and/or my minor child to participate in the event and to prevent/treat injuries sustained during participation in the event.

ASSUMPTION OF RISKSDETAILSPhysical activity, by its very nature, carries with it certain inherent dangers and risks that cannot be eliminated regardless of the care taken to prevent or minimize harm. Autism Soccer has facilities for various sport specific activities such as soccer, golf, tennis, baseball, track, lacrosse, football and basketball and related activities such as physical training, running, weight training, and swimming. Some of these activities involve endurance or strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of direction, some involve contact with equipment, fixed objects (e.g. goal posts), other participants (including participants that are older or younger and who may be larger or smaller in terms of weight and height) and various surfaces types, and others involve sustained physical activity that places stress on the cardiovascular, muscular, skeletal and nervous systems.

LIABILITY WAIVER & RELEASEDETAILSIn full knowledge and complete assumption of all of the risks, the Releasors, for themselves and, to the extent applicable, on behalf of the Participant’s parents, grandparents, spouse, domestic partner, children, and each of the foregoing’s estate, heirs, assigns, executors, and administrators (the Releasors collectively with the foregoing, the “Releasing Parties”) hereby irrevocably agree that the Releasing Parties will not sue or claim against Autism Soccer or any of its parents, subsidiary entities, affiliates, sponsors, successors and assigns and each other person or entity who attends, participates in or provides services in connection with the Activities and the respective directors, officers, members, managers, employees, agents, service providers, sponsors, business partners, contractors, partners, equity holders and representatives thereof, in their individual, personal and representative capacities for each of the foregoing entities, and each of the foregoing’s estate, heirs, assigns, executors, administrators and affiliates (the “Released Parties”) for any claim, injury, illness, damage, loss or harm to any Releasing Party or such Releasing Party’s property or the Releasing Party’s death or disability, resulting or arising out of or in any way related to the Participant’s preparation for, travel for, participation and appearance in, and/or attendance at the Activities.

INDEMNIFICATIONDETAILSThe Releasors, on behalf of themselves and the Releasing Parties, hereby covenant and agree that neither they nor any Releasing Party shall hereafter bring any claim, action or proceeding against any Released Party, nor shall the Releasors assign or permit any of the Releasing Parties to assign any claim, action or proceeding arising from, and shall indemnify, defend and hold harmless the Released Parties from, any claims, actions, proceedings, expenses (including attorneys’ fees) and damages arising from, relating to or in connection with, this Agreement, including claims by Releasing Parties or third parties alleging negligent or intentional acts or omissions by the Releasors or any other Released Party or the breach of any of the Releasors’ representations, warranties or covenants contained herein, or in connection with defending any claim against any Released Party relating to the matters covered by this Agreement or enforcing this Agreement against a Releasing Party, and that such Releasing Party(ies) shall not participate in or cooperate with any investigation, claim, action or proceeding arising from, relating to or in connection with this Agreement or the Activities.

ARBITRATION/DISPUTE RESOLUTIONDETAILSAll claims or disputes between the Releasing Parties and the Released Parties, including those arising out of or related to this Agreement or to Participant’s activities with Autism Soccer such as, without limitation, any claim based on breach of contract, breach of duty, negligence, gross negligence, fraud, or misrepresentation (collectively the “Disputes”) will be resolved through binding, confidential arbitration conducted in accordance with the then current Consumer Arbitration Rules of the American Arbitration Association.

MEDIA RELEASE AND TECHNOLOGY CONSENTDETAILSReleasors hereby grant to Autism Soccer and any and all persons and/or entities acting within its permission and upon its authority, including, without limitation, the Released Parties the right to (a) capture, photograph, and record the Participant’s image, likeness (including, without limitation, aural and visual likenesses), voice, persona, statements, name, biographical information, physiological data, performance data, athletic statistics and accomplishments, and other data about the Participant (via film, videotape, audiotape, digital media, athletic and nutrition based technology or otherwise) (collectively, “Participant Data”); (b) aggregate, analyze, transfer, store, edit, modify or otherwise process any resulting photographs, recordings, digital files or other media or materials, including Participant Data (the “Materials”); and (c) use and distribute the Participant Data and Materials, in whole or in part, in any manner and in all media formats and channels now known or later developed, and for any purpose whatsoever at the sole discretion of Autism Soccer, including, but not limited to, analytical, research, promotional and publicity purposes, including in publications, marketing, and promotional materials, websites, databases, press releases, advertising media, research materials and studies, and any other works based on or incorporating the Materials (collectively, the “Media”) and to promote the Participant to prospective recruiters, partners, and sponsors, in each case, without payment to, or additional review by or consent of, Releasors.

AUTOMATIC PAYMENT AND RELEASOR RESPONSIBILITY FOR WITHDRAWALDETAILSBy enrolling in Autism Soccer, Releasors agree to the following terms regarding automatic payments and withdrawal from the program: Automatic Payment Authorization: By signing this Agreement, Releasors authorize Autism Soccer to automatically charge the designated payment method for tuition, fees, or any applicable charges on a recurring basis as agreed upon at the time of enrollment. Releasors’ Responsibility to Cancel Payments: If Releasors choose to withdraw from Autism Soccer, it is Releasors’ sole responsibility to cancel the automatic payment at least 5 days before the next scheduled payment. No Refunds or Prorations: All fees paid for participation in the Program are non-refundable and non-transferable, regardless of the reason for withdrawal, absence, dismissal, or early termination. Agreement to Terms: By enrolling in Autism Soccer, Participant acknowledges and agrees to these terms regarding automatic payments and withdrawal.

ACKNOWLEDGEMENT OF RULES AND STANDARDS OF CONDUCT; FORMSDETAILSReleasors understand that Autism Soccer has rules and standards of conduct that are applicable to all participants. Releasors agree to abide by these rules, standards, and policies for the safety of all participants, guests, invitees, contractors and employees. Any consequences that come as a result of violating the rules and standards are at the discretion of Autism Soccer. Releasors certify that any and all forms, documents and reports delivered by the Releasors to Autism Soccer on, prior to or after the date(s) of the Activities are accurate and complete.

SEVERABILITYDETAILSIf any provision of this Agreement is found to be invalid, illegal or unenforceable under applicable law, it shall not affect the validity, legality or enforceability of any other provision of the Agreement. Rather, the invalid, illegal or unenforceable provision shall be modified to the extent necessary to make valid, legal and enforceable.

OTHER AGREEMENTSDETAILSThis Agreement is made in addition to, and shall not serve to reduce or limit in any manner whatsoever any of the rights of Autism Soccer or any of the Released Parties or expand any of the obligations of Autism Soccer or any of the Released Parties under any other agreement between Autism Soccer or any of the Released Parties, on the one hand, and the Releasors or any of the Releasing Parties, on the other hand; provided, that, notwithstanding the foregoing, to the extent of any conflict between any term or provision of this Agreement and any term or provision of any other agreement relating to the Activities or otherwise that would, in each case, reduce or limit the rights, or expand the obligations or liabilities of, Autism Soccer and/or the Released Parties, in relation to the matters contemplated hereby, the terms and provisions of this Agreement shall govern and control exclusively and the conflicting terms and provisions of such other agreement shall be of no force or effect.

THIRD-PARTY BENEFICIARIESDETAILSEach Released Party is an express third-party beneficiary to this Agreement; provided, that no Released Party (other than AUTISM SOCCER) may enforce this Agreement except at the direction of Autism Soccer. This Agreement shall not be construed as giving to any person, other than the Released Parties, any legal or equitable right, remedy or claim under or in respect of this Agreement.

ACKNOWLEDGMENT OF UNDERSTANDINGDETAILSReleasors hereby represent, warrant and certify that he/she/they (a) have the full right, power and authority to enter into this Agreement; (b) are aware that this Agreement is, among other things, a release of liability for future injuries and a contract between the Releasors and Autism Soccer and the other Released Parties and that the Releasor(s) is/are signing this Agreement of his, her or their own free will and is not subject to duress of any kind; (c) received the opportunity to review this Agreement and further acknowledge to have carefully read and fully understand the contents of this Agreement and have asked, or had the opportunity to ask, and received answers to all questions he/she/they may have; (d) have made such an investigation into the facts pertinent to this Agreement and of all matters pertaining thereto as they have deemed necessary, that the Releasors fully understand the contents of this Agreement; (e) have reviewed this document with their own legal counsel prior to signing (or, alternatively, the Releasors have been afforded the opportunity to review this Agreement with their own legal counsel prior to signing, and has decided, in her, his or their sole determination, not to do so); and (f) are of sound mind, have duly executed this Agreement freely and voluntarily, intending and agreeing to be fully bound by the terms. If any portion is held invalid, the remaining portion of this Agreement will continue in full legal force and effect. This Agreement shall be governed by the laws of the State of Florida and shall be interpreted as broadly as permitted by F.S.A. 744.301 or other applicable Florida law.

Legal Guardian Full Name Signagure

Date

I AM SIGNING THIS AGREEMENT REPRESENTING THAT I HAVE THE LEGAL AUTHORITY TO ENTER INTO THIS AGREEMENT ON BEHALF OF MYSELF AND MY MINOR CHILD (AS APPLICABLE), KNOWING THAT I AM WAIVING THE ABILITY TO BRING CERTAIN CLAIMS AND TO SEEK CERTAIN REMEDIES ON BEHALF OF MYSELF AND MY MINOR CHILD, THAT I AM WAIVING MY AND MY MINOR CHILD’S RIGHTS TO BRING CLAIMS IN COURT, AND THAT I AM ACCEPTING, ON BEHALF OF MYSELF AND MY MINOR CHILD, VARIOUS RISKS (KNOWN AND UNKNOWN). I AM INTENTIONALLY WAIVING SUCH RIGHTS AND ACCEPTING SUCH RISKS BECAUSE I DESIRE THAT I AND/OR MY MINOR CHILD WILL ATTEND AND/OR PARTICIPATE IN THE EVENT(S), ACTIVITY(IES) AND OTHER EVENTS AND ACTIVITIES RELATED THERETO.

Registration Form – Autism Soccer

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