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TOCA Continuity Soccer Program
2018 Fall Training
Keep younger players active
MINIS (Girls & Boys - Ages 4 to 9)

 
Program Registration/Waiver Form
Player Full Name:
Gender:
Date of Birth:
Parent Full Name:
Street Address:
City: State: Zipcode:  
Program:
 
 
Ages 4 to 9
Returning Members
New Members
 
Session:
Full session
Half session
 
Payment:
Paypal
Check
Please indicate how you heard about Fall training program:
Friend
Website
Social Media
Email Marketing
Flyer
If is other please specify:
Insurance Company:
Policy Number:
Primary Email:
Alternate Email:
Home Phone: Cell:
Questions?!::
 
Medical Treatment Authorization and Liability Waiver
• I hereby release Toca Juniors FC and all of its coaches, staff and members from any and all liability for injury or medical problems incurred by the player in this registration while attending and participating in activities run by the Club.
• 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 player listed below 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 player listed above 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, Toca Juniors FC, Coaches, 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 Toca training Program and/or being transported to or from the same, which transportation I hereby authorize.
• I understand that I am required to have accidental medical coverage for the child listed on this waiver, and I verify that the information provided on this form is accurate and true. I understand and agree that if I do not have accidental medical coverage for the child listed on this waiver, I will be financially responsible for all charges and fees incurred in the rendering of said treatment.
• I understand that at the discretion of the camp coach and staff my child may be dismissed from the camps without refund for inappropriate behavior.
• I understand that at the conclusion of the scheduled camp time the program and staff are no longer responsible for my child.
 
Photography/Video Consent And Release Form
• I hereby grant permission to Toca Juniors Football Club representatives, to take and use videos, photographs and/or digital images of my child for use in:
1. Media releases, media articles - including newspapers, radio, television - printed publications and/or educational materials.
2. Electronic publications and communications such as the club's Social Media and website.
3. I agree that my child's name and identity may be revealed in descriptive text or commentary in connection with the image(s).
4. I authorize the use of these images without compensation to me. All negatives, prints, digital reproductions and shall be the property of Toca Juniors Football Club.
Relation to player (choose one):
Father
Mother
Guardian
Signature Date:
Parent/Guardian Print Name:
• I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.