2018-2019 REGISTRATION PACKAGE & CHECKLIST

1 123456789 Sunrise SC Player REGISTRATION FormMedical ReleaseCity of Sunrise REGISTRATION FormCity of Sunrise REGISTRATION Payment2018-2019 Player REGISTRATION Contract information read and signedParent Code of Ethics (signed)Informed Consent about Concussions (signed)Copy of Player Birth Certificate (for NEW players to Sunrise SC or FYSA)10 Proof of Entry Prior to 12 Years of Age (read below carefully)11 Proof of Entry After 12 Years of AgeIf the player is new to FYSA and was born outside of the United States and entered the United States before the age of 12, fill out this form and return it with a proof of entry before age 12.

2 This would include school records (such as a report card) or health records from a contact your team manager for Form2018-2019 REGISTRATION PACKAGE & CHECKLISTC ongratulations and Welcome to the Sunrise SC Family. In order to expedite the process at REGISTRATION , pleas e arriv e wit h completed forms & required payments. We will have limited copies of the player REGISTRATION packet available. If you have any questions, please contact your Team' s Head CoachIF THE PLAYER WAS BORN OUTSIDE OF THE UNITED STATES, SEE BELOWPLAYER REGISTRATION FORM LAST NAME _____ FIRST NAME _____ MIDDLE INITIAL _____ DATE OF BIRTH _____ ADDRESS _____ CITY_____ ZIP _____ EMAIL _____ TEL# _____ Did you play competitive soccer last year_____ if yes.

3 Where _____ INSURANCE NOTICE All injuries must be reported within 30 days of the date of injury. FYSA has an Excess Accident Coverage policy for registered members of FYSA. This is a limited policy with a deductible (details at ). Do you have other medical/dental insurance? Yes _____ No_____ (If yes, please identify name of insurance company_____ Policy# _____ Fees there is a City REGISTRATION fee ($125 for Sunrise residents/$175 outside the City) that is payable to the City of Sunrise. If a player is carded and is subsequently released before the season ends, there is a $300 charge.)

4 Any Release is solely at the discretion of the Sunrise Soccer Club. Any other fees and/or expenses are team fees for team expenses and are not the managed by the Club. Contact your team manager or coach for details on that. INFORMED CONSENT I, _____(Name), acknowledge that I am completely aware of the inherent risks associated with soccer, and hereby wave, release, and discharge the state association (FYSA), and all of its affiliated organizations including the Sunrise Soccer Club, as well as their officers, directors, employees, agents, volunteers (collectively, the Released Parties )

5 , from any and all liability and responsibility in the event that I become injured in any way during my participation in soccer events or any other activities associated with the Released Parties or with the team or the Club. I further state that I take full responsibility for any injury that may occur as a result of my participation, and that I will not hold the Released Parties responsible for any aggravation of preexisting injuries prior to or during my participation in any soccer events or activities associated with the Released Parties.

6 Player Signature _____ Parent Signature _____ Date: _____ 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 #.

7 PARENT S APPROVAL AND MEDICAL RELEASER ecognizing 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.

8 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 PLEASE NOTE: FLORIDA PUBLIC RECORDS LAW REQUIRES THAT ALL INFORMATION INCLUDING E-MAIL ADDRESSES RECEIVED IN CONNECTION WITH CITY BUSINESS BE MADE AVAILABLE TO ANYONE UPON REQUEST, UNLESS THE INFORMATION IS SUBJECT TO A SPECIFIC STATUTORY EXEMPTION.

9 PLEASE SEE REVERSE FOR REQUIRED RELEASE AND WAIVER. The Release and Waiver on the back of this REGISTRATION form must be completed and submitted in order for a REGISTRATION to be accepted. Refunds for one-day programs, Kids Day Off, Mini Camps and Holiday Camps will only be granted if requested 24 business hours prior tothe start of the activity. Refunds will not be granted for all other programs if requested four (4) weeks or more after the start of the activity,or if attendance has met or exceeded 50% of the activity. Refunds will be pro-rated.

10 All refund requests must be submitted in writing toLeisure INFORMATION & REFUND POLICIESM asterCard Visa Discover Expiration Date / / Card # Signature as it appears on the cardI agree to pay the above amounts listed as credit card charges according to credit card user CARD PAYMENT / /Emergency Contact Relationship to ParticipantHome Phone Work PhoneCell PhoneAllergies or medications (specify which child)EMERGENCY CONTACT(Other than parent/guardian. To be contacted in the event that parent/guardian listed above cannot be reached.)