Registration packet 2015.16
Transcription
Registration packet 2015.16
1 MICHIGAN RUSH JACKSON Player Registration Pack 2015/16 Welcome to Michigan Rush Jackson. We look forward to working with your player and hope this year will be a fun, challenging and rewarding year for each player. Registration Process Includes: 1. Online Registration: Complete Prior to June 18, 2015 Link: ! Only exception is do not register if applying for OPS Scholarship until you receive scholarship confirmation, by June 27th. 2. Turn in Documents: ! ! ! ! ! ! ! Family contact information sheet Player contract: only if not signed at tryouts " CMSA Forms U8-U10,WSSL U11-U12, MSPSP U13-U18 Notarized MSYSA medical release (U8-U10 Players Also need CMSA Medical Release) Rush Accident Waiver Website waiver Concussion Waiver, 2 copies OPS Scholarship Fund, if applying for a Scholarship give directly to Josh McKenna 3. Club Registration Night: Thursday June 18th 5:00-8pm at Grace Church, 2692 N. Dettman Road, Jackson Located at the Gym in back entrance and parking lot • 5.00-5:45pm U8-U11 Teams • 5:45-6:30pm U12-U14 Teams ! 6:30-7pm U15-U18 Girls Teams ! 7-7:30pm U15-U18 Boys Teams What to do at Registration Day? ! ! ! Find the coach/manager from your team. He/She will be at a table. Turn in required paperwork to your coach/manager. Try uniforms on, write sizes down for all items, if needed. You will have to order and pay for everything online at a later date and pick up Eurosport’s online ordering form to help with the online ordering. You will receive a follow up email with further ordering instructions. After Registration Day ! ! ! Order uniforms (Follow Eurosport online instructions) Your team coach will contact you regarding Fall team training times See everyone at team camp! " U9-U14 July 28th-31st 9am-12pm/ U15-U18 Girls July 28th-31st 6:30-8:30pm If you have any questions please contact your team coach/manager or Josh McKenna, [email protected], 352.422.4053 # # 2 Overview of Paperwork to be Filled Out: $% CMSA Players Teams: ! Pages 3, 4, 5, 6, 9 &% WSSL Players & Teams: ! Pages 3, 4, 5, 7, 9 '% MSPSL Players & Teams: ! Pages 3, 4, 5, 8, 9 **Page 9, Medial Release Form, must be notarized. # # 3 MICHIGAN RUSH Jackson Family Contact Information Player’s Name _____________________________________________________________ Mother’s Name ________________________________________________________________________ Father’s Name ________________________________________________________________________ Player’s Date of Birth (MM/DD/YYYY) ________________________________________________________________________ Mailing Address (Street, City, Zip) ________________________________________________________________________ ________________________________________________________________________ Player’s Email ________________________________________________________________________ Mother’s Email ________________________________________________________________________ Father’s Email ________________________________________________________________________ Player’s Cell (123-456-7890) ________________________________________________________________________ Mother’s Cell ________________________________________________________________________ Father’s Cell ________________________________________________________________________ Emergency Contact (Name and Number) ________________________________________________________________________ Please write legibly # # 4 ACCIDENT WAIVER AND RELEASE OF LIABILITY MICHIGAN RUSH 2015-2016 I acknowledge that participation in the Michigan Rush carries with it the potential for injury. I certify that I am physically fit to participate and have not been advised otherwise by a qualified medical personal. I acknowledge that this Accident Waiver and Release Liability form will be used by the Michigan Rush, and that it will govern my actions and responsibilities. Player and parent acknowledge the following: I acknowledge that there are certain anticipatable dangers associated with participating in Club events, Optimal Performance Specialist (OPS), including participation in indoor and outdoor soccer practices, competitions, and travel to and from those practices and competitions. I assume all risk and hazard of injury to player in the course of a club event. I acknowledge that the club and OPS 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 the Club events. On behalf of themselves and their assignees, release and hold harmless the Club and OPS 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 also waive as to the club, and to all of their directors, officers, officials, employees, coaches, representatives and agents (“Club Affiliates”), any claim or damages Parent and/or Player may have as a result of the Parent and Player participation in a Club Event (including transportation to and from the event) and including any facilities provided directly or indirectly by the club. I shall hold harmless and indemnify the Club, and Club 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 Player and/or any parent, guardian, sibling or other relative of Player, who attends and participates in a Club or OPS Event and any injury to Player him/herself. I acknowledge that this document shall be operative as to any Club event which occurs now or in the future and in which Player is participating, Regardless of teams, participants, facility or location, and that no coach or official, other than the full Michigan Rush Board, may waive or alter the terms of this document. Player and parent 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: Player Name: _________________________Team:________________________ “Parent” Acceptance As a parent or guardian of the Player identified above, I have reviewed the Accident Waiver and Release of Liability form and ACCEPT the terms and conditions contained herein. Parent/Guardian Signature: _________________________Date:_________________ Parent/Guardian Signature: _________________________Date:__________________ # # 5 MICHIGAN RUSH PLAYER INFORMATION Website Waiver /Authorization and Release 2015-16 I am the parent or legal guardian of ____________________________________ (“Player”), and I consent and authorize the Michigan Rush Club, or any of its affiliates, Club teams, past and present officers, representatives, coaches, managers, agents, or employees (collectively, “Club”) to use and reproduce Player’s name, profile, background information, athletic participation history, academic history, grade point average, test scores, statistics, honors, or any other information provided by me (us) on the Player Profile Form (“Profile Information”), and I further authorize Club to edit, modify, or rearrange Profile Information for posting to a website, printing, reproducing, publishing, or disseminating in any other manner. I also consent and authorize the Club to take photographs (“Photos”) of Player and to post the Photos on the Club’s website, or print, reproduce, publish or otherwise disseminate such Photos in Club marketing materials; provided, however, the Player’s name or other personal information will not appear with the Photos unless it is part of the Profile information provided by me (us). I hereby waive and release Club from any and all actions, causes of action, lawsuits, claims, injuries, warranties, trespasses, torts, losses, agreements, promises, demands or other liability or relief of any nature whatsoever, whether known or unknown, foreseen or unforeseen, resulting from the Club’s use of Photos or Profile Information as authorized by this Authorization and Release. I promise to indemnify and hold harmless Club from any claim or action the Player, Player’s parent or legal guardian, or anyone brings against Club as a result of any use authorized by this Authorization and Release form. I acknowledge that I have voluntarily provided the Profile Information for this use, and that this Authorization and Release is given voluntarily. Player Name______________________________________ Team__________________________ Parent/Guardian________________________________ Date___________________________ # # 6 # # 7 WESTERN SUBURBAN SOCCER LEAGUE PLAYER REGISTRATION FORM - Fall 20______ / Spring 20______ Name________________________________________________________________________________________ LAST FIRST MIDDLE Address ___________________________________________________ Date of Birth________________________ MONTH DAY YEAR City __________________________State ______ Zip_______________ Phone (_________)_________-________ I voluntarily desire to play soccer for the _____________________________________________________ AFFILIATING CLUB or ASSOCIATION TEAM NAME competing in the Western Suburban Soccer League (WSSL). I understand that signing this form binds the above named player to the above named affiliating club or association for the entire seasonal year (both Fall/Spring) unless an application for the transfer to another league is approved by the WSSL using the WSSL Player Transfer Form. Transfer between WSSL Clubs or Associations will NOT be approved. Signature of Player ! _____________________________________________________ Date _______________ Signature of Parent/Guardian ! _____________________________________________Date _______________ I understand that signing this form binds the above named affiliating club or association to the above named player for the entire seasonal year (both Fall/Spring) unless an application for the transfer to another league is approved by the WSSL using the WSSL Player Transfer Form. Transfer between WSSL Clubs or Associations will NOT be approved. Signature of Coach/Team Official ! __________________________________________ Date _______________ Signature of Affiliating Club or Association President or Registrar ! _________________________________________Date _______________ I, as the Affiliating Club or Association President or Registrar, confirm documentation is on file with the Affiliating Club or Association that certifies the player’s age eligibility. WESTERN SUBURBAN SOCCER LEAGUE Athletic Waiver and Release of Liability In consideration of being allowed to participate in any way in WSSL sanctioned soccer activities, the undersigned: 1. Acknowledges and fully understands that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions and/or inactions, but the negligence of others, the rules of play, or the condition of the premises or of any equipment used, and acknowledges further, that there may be other risks not known or not reasonably foreseeable at this time; 2. Assumes all the foregoing risks and accepts personal responsibility for the damages following such injury, permanent disability or death;3. Releases, waives, discharges and covenants not to seek any legal action against the WSSL, its member Associations, Affiliated Clubs, or teams and their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter, referred to as “Releasees”; from demands, losses or damages on account of injury, including death or damages to property, caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise; 4. Agrees, in further consideration for my child’s participation, to hold harmless and indemnify the “Releasees” for any injury resulting from my child’s conduct in the program; 5. Agrees to accept and abide by all the rules, regulations, code of conduct and policies stated by the WSSL. Printed Name of Parent/Guardian_________________________________________________ Signature of Parent/Guardian !___________________________________________________ Date______________ # # 8 # # 9 # # 10 Optimal Performance Specialists Scholarship Fund Michigan Rush Jackson Financial Assistance Request Form 2015-2016 Player’s Name: _____________________________ Age Group (ex: U12 Boys): ________ Years Played within Rush: ____________ Parent 1 Name: _____________________________ Parent 2 Name: __________________________ Address: ___________________________________ Address: _________________________________ Home Phone: Work Phone: Cell Phone: Email: EMPLOYMENT Parent 1: Currently Employed: Yes No Occupation: Home Phone: Work Phone: Cell Phone: Email: Name of Employer: Phone: Parent 2: Currently Employed: Yes No Occupation: Name of Employer: Phone: INCOME Annual Gross Income (combined if two parent income): __________ Household Members (list names and ages): ____________________________________________________ Briefly explain the reason(s) for your request; use back of form or attach a separate page. Financial Assistance Matrix (used to determine level of assistance): Part A: Age Group and Annual Fee Part B: Requested Percentage of Assistance U15-U18 HS/Nero: $687 U15-U18 Girls: $892 U15-18 Girls: $907 U13-14 Boys/Girls: $1,275 U11-12 Boys/Girls: $1, 262 U9-10 Boys/Girls: $970 U8 Boys/Girls: $480 10% assistance = .9 20% assistance = .8 25% assistance = .75 50% assistance = .5 75% assistance = .25 Calculate Total Club Fee Capable of Paying: $_________ Club Fee from Part A x ________ Requested Percentage of Assistance from Part B (ex: 75 % assistance = .25) _____________ Requested Total Club Fee to be Paid by Family/Guardian Ex: $1,275 (u14 boys) x .25 (75% assistance) = $324.25 Financial Aid is NOT guaranteed. An email will be sent to your family by June 27th, 2015 notifying you of the level of support you will receive. All club fees will be collected after the club has responded with the level of financial aid your # # 11 family will receive, do not make online parent until the club confirms scholarship amount rewarded. A payment plan will be offered to your family outlining the amount of money due, along with when it is due. Failure to meet the minimum monthly payments, and to attend sessions and/or games regularly may result in loss of assistance and/or removal from the program. I declare the above personal and financial information is accurate and I will submit my most recent federal income tax form or form with proof of income. I understand that receiving financial assistance is a privilege and pledge to have my child at all team activities with soccer as a priority over other athletic activities, and pledge for my family and/or I to volunteer at club events (tryouts, Rose City Soccer Tournament, etc.) as assigned by the club directors. Failure to honor commitments may result in loss of assistance and/or removal from the program. I also recognize the scholarship may cover partial fees and I am responsible for paying the remaining balance, and I am responsible for non-club expenses (personal travel, extra events/expenses outside club fees, uniforms, tournaments ref fees, etc.) Financial assistance recipients must notify the club directors of their intentions for the 2014-15 soccer year (leaving for a new club, remaining with the club, not playing soccer, etc) in writing by May 15, 2015. Failing to do so could result in the forfeiture of any future financial assistance. Parent(s) signature: Date: All information submitted and any financial assistance granted will be kept strictly confidential by the officers of the Rush Jackson Soccer Club. Completed applications can be turned in at Club Registration evening on June 18th or emailed to [email protected]. Please place your application and proof of income in a manila or mailing envelope with the players name on that envelope. Applications will be reviewed and families will be contacted regarding their financial assistance by June 27, 2015. APPLICATIONS are due by June 18, 2015. If forms are not turned in by June 18 you may not be considered for financial aid. Please use the other side or attach a separate page if you would like to add additional information regarding your family’s situation. If you have more than one child in the Rush Jackson Soccer Club and would like financial assistance for each child, please use one form for each child. Questions: contact Josh McKenna, 352-422-4053, [email protected] Volunteer Events for Families Receiving Financial Assistance • • • All times/dates/responsibilities are subject to change Families will be assigned responsibilities based on the level of financial assistance received Responsibilities may include involvement before, during and after events Club/Team Fundraisers: (PARENT AND/OR PLAYER HELP) • Some Rush Jackson teams may chose to participate in various fundraisers to off set additional fees (tournament, team travel, rush festival, etc.) • Volunteering to help coordinate these efforts would be helpful Rose City Soccer Tournament: club tournament June 3-5, 2016 (PARENT AND/OR PLAYER HELP) Pre-tournament: organize binders, solicit sponsors/advertisers June 3: help set-up event June 4-5: on-site tournament help at Cooperstown, Marino’s or Ella Sharp Soccer Complexes (set-up/clean-up, score reporting, field marshal, concession sales, etc.) 6-10 AM, 10 AM-2 PM, 2-6 PM, 6-10 PM 2015-16 Club Tryouts: field set-up/clean-up, player registration, etc. at Marino’s Park (PARENT HELP) # # 12 # # 13 # #