SELECT PLAYER COMMITMENT FORM Birth Year

Transcription

1 SELECT PLAYER COMMITMENT FORM Birth Year By Signing this Document, I Agree to the Following: I/We are applying to register the player named above as a member of FKK for the year. I/We understand that this commitment is for the June 2017-June I/We understand that the selection and team placement of players shall be the discretion of the FKK coaching staff and is subject to change. I/We agree to abide by the rules, agreements, and policies (including Parent and Player guidelines and responsibilities) of Florida Kraze Krush, and all leagues that Florida Kraze Krush participates in. I/We agree that the continued participation of a player is contingent upon the player and his/her family continuing to adhere to the rules, agreements and policies of all leagues and tournament we participate in and those referenced above. FEES: Annual Fee ECNL Team $1, Annual Fee Select Black Team $1, Annual Fee Select White Team $1, Annual Fee - Select Blue Team $1, A $25.00 discount is available if fees are paid in their entirety at time of commitment signing Club Fees: PAYMENT SCHEDULE: First payment required upon signing of commitment (non-refundable) - $ All additional payments are due on the fifteenth (15) day of the month as follows: Month ECNL Black White Blue June 15 $190 $174 $158 $116 July 15 $185 $171 $157 $114 August 15 $185 $171 $157 $114 September 15 $185 $171 $157 $114 October 15 $185 $171 $157 $114 November 15 $185 $171 $157 $114 December 15 $185 $171 $157 $114 Total Payments $1300 $1,200 $1,100 $800 PAYMENT PLANS MUST HAVE A CREDIT CARD ON FILE FOR AUTOMATIC PAYMENTS. Checks for full payment should be made payable to the FKK Soccer Club All monthly payments are the responsibility of the player s family. There will be a late fee charged of $15.00 for payments more than 15 days late if your credit card is declined or the draft is denied. Fees include: Team Camp League Registration Fees Club Administration Fees Field Usage Fees League Referee fees Club Training fees SSP/Skills training Failure to pay: Failure to pay your fees within thirty (30) days of fee payment due date will invoke the no pay, no play Club policy and the player s ID card will be held by the FKK Club until the past due payment is received. Players will be ineligible to participate in team practices, games and tournaments until the payment is received. FKK realizes that emergencies may result in a financial strain on the family and in order to keep the player from being ineligible the Club will work with a family if they contact the office in a timely manner. (The 30-day rule applies to all payments except the team fees. All team fees must be paid by date due). 1

2 TEAM FEES: Team fees must be paid directly to the team manager/treasurer by check. Team Fees Include: Elective Tournament entry fee as determined by club/coach for each individual team Coaches travel expenses ECNL teams and U14 and older will travel together as teams Participation in Pink Jersey or Cancer month fundraiser. Media Guide Team travel Team basket for the End of the Year Party Team Snap payment Non-league referee fees Scrimmage referee/ Scrimmage game fees REFUNDS: Club fees: Club fees remain the same regardless of the duration of the season. No fee payment or parts thereof will be refunded or forgiven because of player absences, withdrawals, or release from a team. Exceptions may only be if the player provides documented proof of an injury that prevents them from playing for more than half of the season or due to a parent s job relocation providing proper documentation. Training fees may be prorated and refunded accordingly. Team fees: Team fees are fluid depending on the tournaments planned, what the team is accepted to and the variable costs of travel. Every player is responsible for team fees regardless of tournament attendance. There will be no refund of team fees. Sibling Discount: If you have more than one child in the club you will receive a 10% discount for the child playing in the least expensive program. The sibling discount will be applied to one child only and taken off of the final payment. To request a sibling discount please fill out the form on the website in the member area under parents. Financial Aid: If an alternate payment plan or financial assistance is needed, completion of the Financial Assistance Application and an IRS form 4506T form is required. A minimum nonrefundable deposit of $ must be turned in with your application. All paperwork for the club must be submitted at the same time. If award is accepted the money will be credited to the club fees. Financial assistance paperwork must be turned in within 7 days of registering with the club. A decision will be sent in writing by from the financial aid/scholarship committee. Your account will not be credited until the form is signed and returned. You will have required volunteer hours. NOTE: If you have multiple players in the club and need assistance with payments, or are requesting an extension of payments, a request can be made for financial assistance. Completion of the financial assistance application must be completed at the time of registration and submitted for review. Please contact the Club Administrator at koettl@floridakrazekrush.com, if you have any question. All forms may be found on our website in the member area under parents. Uniforms:(separate fee) Mandatory Uniform Kit* All players** Youth and Adult Sizes $ *Note: Nike Uniform Kit include two game jerseys with player number, two game shorts, two pairs of game socks, two practice jerseys, one practice short, one pair of practice socks, one full warm-up kit ( jacket and pants) one backpack all with club logos and Nike ball. ***Travel polo (required for all players U14 and above) ordered through WeGotSoccer separately) Players will receive your number from the team manager. **Note: Nike Goalkeeper Kit is the same as the mandatory uniform kit but consists of red & volt game jerseys and black shorts, orange practice shirt. Payment for the uniform is required when the order is placed with WeGotSoccer.com. All uniforms will be ordered from and paid directly to WeGotSoccer. Team Camp will be held Saturday, July 29 th Sunday July 30 th, Tuesday Aug 1 st and Wed Aug 2nd (Saturday and Sunday included). The Select teams will practice once a day during Team Camp. On the first day of the team camp, Spectrum Sports Performance (SSP) will do their annual preseason testing for all the players. Please note this is the ONLY day that there will be SSP testing. No make-up day is scheduled. Players should make every effort to attend. These results will be distributed to the coach and player after tabulation. It is highly recommended that you attend this camp. Inter-club games are scheduled for Saturday and Sunday, August 5 th and 6 th. 2

3 Got Soccer Log in Info: Username: Password: Amount paid Ck # or CC Initials Registered FA SELECT PLAYER AGREEMENT: Player name Initial Team Assignment: I have received a copy of the Player Commitment Form. All players and their families are expected to abide by and support the policies and procedures included therein. If you have any questions, please contact the Club Administrator. I understand that I am responsible for all club fees and team fees for the season. I understand that I am responsible to pay team fees even if I decide not to attend a tournament. All players are expected to meet a high standard of commitment to training and play. Players are expected to attend all pract ices and participate in all league games and tournaments. All players and parents are expected to read and abide by the player handbook. If you have any questions, please contact your team coach or the age group coordinators. I understand that we are a Nike club and agree that my player will train and play only in the Nike gear that the club requires. Although we strive to provide quality playing time for all players, there are NO guarantees of playing time in any single game for Premier Players. All players should expect to play in several tournaments on holiday weekends, including Labor Day, Thanksgiving and possibly others. I understand and accept my commitment to the Florida Kraze Krush Soccer Club and agree to abide by and support the policies and procedures included therein. I hereby release any officers, coaches, sponsors, or owners/lien holders of properties used by the FKK Soccer Club from any and all claims and causes of action of any kind whatsoever which the undersigned has or might have, known or unknown, now existing or might arise in the future, directly or indirectly attributable to any injury or damage that might result from my child s participation in soccer activities. I agree that Florida Kraze Krush Soccer Club may use pictures of my child for any lawful purpose for such purposes as player identification card, publicity, illustration, advertising, and Web content. I authorize Florida Kraze Krush Soccer Club, its assigns and transferees to copyright, use and publish my child s sports photos in print and/or electronically. I have read and understand the above I understand that I am responsible for Club fees and Team fees as described above. I understand if these fees are not paid, then the player will be ineligible to participate in team practices, games and tournaments until payment is received. Parent/Guardian Signature Printed Name Date Address (include City and Zip Code) Cell Phone # address 3

4 Permission to Roster Form Players Name: Date of Birth: Players Age: Phone Number: Circle: Male Female Father s Name: Mother s Name: Cell Phone Cell Phone Family Address City: St: Zip Code: INFORMED CONSENT/INSURANCE NOTICE FYSA RECOMMENDS THAT PLAYERS NOT REGISTER TO A TEAM WHOSE AGE GROUP EXCEEDS THE PLAYER S NORMAL AGE. It is FYSA s policy that all players compete at a level they are capable of both physically and developmentally. For a player to move up more than one normal age grouping will require approval from the affiliate s director of coaching or agent of record, and the FYSA Director of Coaching. INSURANCE NOTICE: All injuries must be reported within 90 days of the date of the injury. INFORMED CONSENT: I, the parent/guardian of the registrant, a g r e e that we will abide by the rules of FKK, the state association (FYSA) and all its affiliated organizations. My/our child wishes to participate in soccer during t he season of this registration. I/we realize risks are involved in my/our child s participation. I/we understand that the risk to my/our child includes full range of injuries from minor to severe, and the result could be death, paralys is, or other serious, permanent disability. I/we accept this risk as a condition of my/our child s participation.. I agree that Florida Kraze Krush Soccer Club may use the pictures for any lawful purpose for example such as purposes as publicity, illustration, advertising, and Web content Insurance Notice: All injuries relating to games, practice or team functions must be reported within 90 days of the date of injury. Benefits will be provided for eligible expenses not paid by other health plans after Florida Youth Soccer Association (FYSA) deductible has been satisfied. Do you have medical Insurance? Name of Insurance I, the Parent/Guardian have read and understand the above Insurance Notice and Informed Consent as acknowledge by my signature below. Parent/Legal Guardian Signature Date: Player Signature By signing this form I give Florida Kraze Krush permission to register my son/daughter to play for the above team for the FYSA August 1, - May 31

5 YOUTH PLAYER REGISTRATION FORM This form must be retained by the club for at least five (5) years or until the player s 18 th birthday, whichever occurs last. Oviedo Club Name: City: State: League Name: FL I hereby consent to the above-named club registering me with US Club Soccer. I understand that I may be registered to only one US Club Soccer member club at any time. [Note: it will not be necessary to complete this form again as long as the player is with this club, which will hold this form unless requested by US Club Soccer.] Player s Signature Date Parent/Guardian Signature Date PLAYER S MEDICAL INFORMATION Player s Name: Birth Date: Gender: Female Male Street Address: State: Zip : Address: Parent Name: Home Phone: ( ) Bus Phone: ( ) Address: Cell Phone: ( ) Receive texts? Yes No Parent Name: Home Phone: ( ) Bus Phone: ( ) Address: Cell Phone: ( ) Receive texts? Yes No In an emergency when parent/guardian cannot be reached, please contact the following: Name: Phone 1: ( ) Phone 2: ( ) Name: Phone 1: ( ) Phone 2: ( ) Please list player allergies: Please list other medical conditions: Physician: Phone 1: ( ) Phone 2: ( ) Medical/Hospital Insurance Company: Phone: ( ) Policy Holder s Name: City: Policy Number: MEDICAL TREATMENT AUTHORIZATION AND LIABILITY WAIVER I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player s participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize. Signature: Date: Relation to player: Father Mother Guardian Form #R002-Y 5/2012

6 Player Medical Release Form Player s Name: Date of Birth: SSN: 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 #: PARENT S APPROVAL AND MEDICAL RELEASE Recognizing the possibility of physical injury associated with soccer and in consideration for the USSF/US Youth Soccer and its affiliates accepting the registrant for its soccer programs and activities (the Programs ), I hereby release, discharge and/or otherwise indemnify the USSF/US Youth Soccer, its affiliated organizations and sponsors, their employees and associated personnel, including the owner of fields and facilities utilized for the Programs against any claim by or on behalf of the registrant as a result of the registrant s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programs. I hereby give my consent to have an athletic trainer and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of each assistance and/or treatment. Signature of Parent/Guardian Date

7 Informed Consent about Concussions or Head Injuries Effective July 1, 2012, Florida Statute requires the parent or guardian and the youth who is participating in athletic competition or who is a candidate for an athletic team to sign and return an informed consent that explains the nature and risk of concussion and head injury (including the risk of continuing to play after a concussion or head injury) each year before participating in athletic competition or engaging in any practice, tryout, workout, or other physical activity associated with the youth s candidacy for an athletic team. The facts: A concussion is a brain injury All concussions are serious Concussions can occur without loss of consciousness Concussions can occur in any sport Recognition and proper management of concussion when they first occur can help prevent further injury or even death What is a concussion? A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a ding, getting your bell rung, or what seems to be a mild bump or blow to the head can be serious. Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost, even if they do not directly hit their head. To help recognize a concussion, you should watch for the following things among your athletes: 1. A forceful blow to the head or body that results in rapid movement or the head 2. Any change in the athlete s behavior, thinking, or physical functioning 3. Signs or symptoms of concussion that may be reported by a coach or other observer: a. Appears dazed or stunned b. Is confused about assignment or position c. Forgets sports plays d. Is unsure or game, score or opponent e. Moves clumsily f. Answers questions slowly g. Loses consciousness (even briefly) h. Can t recall events prior to hit or fall 4. Signs and symptoms that may be reported by the player: a. Headache or pressure in the head b. Nausea or vomiting c. Balance problems or dizziness d. Double or blurry vision e. Sensitivity to light f. Sensitivity to noise g. Feeling sluggish, hazy, foggy, or groggy h. Concentration or memory problems i. Confusion j. Does not feel right

8 Both parents/guardians and players are advised to take the Center for Disease Control s free online concussion training. Head s Up Concussion Course Under Florida law, this player who has suspected concussion or head injury must be removed from play or practice. Before the player may return to practice or competition a written medical clearance to return stating that the youth athlete no longer exhibits signs, symptoms, or behaviors consistent with a concussion or other head injury must be received from an appropriate health care professional trained in the diagnosis, evaluation, and management of concussions. In Florida, an appropriate health-care professional (AHCP) is defined as either a licensed physician (MD, as per Chapter 458, Florida Statutes), a licensed osteopathic physician (DO, as per Chapter 459, Florida Statutes), a licensed physicians assistant under the supervision of a MD/DO (as per Chapters and , Florida Statutes) or health care professional trained in the management on concussions. I have read and understand this consent form, and I volunteer to participate. Player Name Signature Date: As a parent or guardian, I have read and understand this consent form and I give permission for my child, named above, to participate. Parent/Legal Guardian Name Signature Date:

9 CODE OF CONDUCT PLAYER NAME: TEAM: PLAYERS I will encourage good sportsmanship from fellow players, coaches, officials and parents at all times. I will remember that soccer is an opportunity to learn and have fun. I deserve to play in an environment that is free of drugs, tobacco and alcohol and expect everyone to refrain from their use at all soccer games. I will do the best I can each day, remembering that all players have talents and weaknesses the same as I do. I will treat my coaches, other players and coaches, game officials, other administrators and fans with respect at all times, regardless of race, sex, creed or abilities, and I will expect to be treated accordingly. I will concentrate on playing soccer, always giving my best effort. I will play by the rules at all times. I will at all times control my temper, resisting the temptation to retaliate. I will always exercise self-control. I will abide by all policies in the FKK Parent/Player Handbook to be found on our website. Date:_ Player Signature_ COACHES/VOLUNTEERS I will never place the value of winning before the safety and welfare of all players. I will always show respect for players, other coaches and game officials. I will lead by example, demonstrating fair play and sportsmanship at all times. I will demonstrate knowledge of the rules of the game and teach these rules to my players. I will never use abusive or insulting language. I will treat everyone with dignity. I will not tolerate inappropriate behavior, regardless of the situation. I will not allow the use of anabolic agents or stimulants, drugs, tobacco or alcohol by any of my players. I will never knowingly jeopardize the eligibility and participation of a student-athlete. Youth have a greater need for example than criticism. I will be the primary soccer role model. I will at all times conduct myself in a positive manner. Coaching is motivating players to produce their best effort, inspiring players to learn and encouraging players to be winners. Date:_ Coach/Volunteer Signature_ PARENTS/SPECTATORS I will encourage good sportsmanship by demonstrating positive support for all players, coaches, game officials and administrators at all times. I will place the emotional and physical well being of all players ahead of any personal desire to win. I will support the coaches, officials and administrators working with my child in order to encourage a positive and enjoyable experience for all. I will remember that the game is for the players, not for the adults. I will ask my child to treat other players, coaches, game officials, administrators and fans with respect. I will always be positive. I will always allow the coach to be the only coach. I will not get into arguments with the opposing team s parents, players or coaches. I will not come onto the field for any reason during the game. I will not criticize or speak negatively to ANY game officials. I will abide by the 48 hour rule and not contact my coach within 48 hours of a game I will abide by all policies in the FKK Parent/Player Handbook to be found on our website. Date:_ Parent Signature_

10 Automatic Payment Plan Authorization Credit Card 2017 Personal Information: Player (s) Name: Team: Age Group: Name and address as it appears on your credit card and statement: Name: Address: City/Zip: Phone number: Address: MasterCard/VISA/AMEX/DISC #: Expiration Date: All approved transactions will be debited on the fifteenth (15 st ) day of the month. Amount authorized: Payment Date ECNL Black Team White Team Blue Team Registration $300 $300 $300 $300 June 15 $190 $174 $158 $116 July 15 $185 $171 $158 $114 Aug 15 $185 $171 $158 $114 Sept 15 $185 $171 $158 $114 Oct 15 $185 $171 $158 $114 Nov 15 $185 $171 $158 $114 Dec 15 $185 $171 $158 $114 I hereby authorize the FKK Soccer Club to charge the account designated above for the amounts authorized on the dates as scheduled, not to exceed the amount agreed to by me, until the balance is paid in full. I understand that I am responsible for making sure the funds are removed from the account. If the funds are not removed, you will be notified by . If the funds are not removed by the 1 st of the month there will be a $15.00 charge. If your credit card is to expire you must notify the club by the 1 st of the month in which the card expires. Signature Date