Please enable JavaScript in your browser to complete this form.Soccer Academy Clinic Registration Form If you would like to take part in our Soccer Academy Clinics, please fill in your details in the Registration Form below. You will NOT be considered registered until you pay in full. If filling out the online registration form, you MUST pay with Credit/Debit Card or PayPal. Waiver - Dayton Sports Complex: By registering for this event, I agree that the participant understands that he/she attending the programs and using Dayton Sports Complex and the facilities does so at his/her own risk. Dayton Sports Complex, outside coaches and their owners, employees or agents, shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant with his/her family in or about any programs on the premises. Participants and parents assume full responsibility for all injuries and damages which occur in or about any programs on the premises, She/he does hereby fully and forever release discharged hold harmless Dayton Sports Complex, all associated facilities and its owner, employees, and agents from any and all claims, demands, damages or rights of action, present or future resulting from any person’s participation in any programs or use of the facility. In addition, he/she agree(s) to follow the rules of conduct and play set by Dayton Sports Complex. Failure to do so may result in suspension from participation. Consent: I the undersigned parent or guardian/participant do hereby grant authority to the staff at Dayton Sports Complex to render a judgment concerning medical assistance or hospital care in the event of an accident or illness during my absence. I do hereby authorize Dayton Sports Complex and its assigns to utilize any and all photographs, pictures or other likeness of me or anyone assigned guardians hip to me, as they deem appropriate in its promotional materials or team films. No refunds will be given. The undersigned understands, acknowledges and agrees that: 1. Participation in such events or activities by my child and myself involves the possible exposure to and illness from infectious and/or communicable diseases including, but not limited to, COVID-19, MRSA, influenza, and other infectious or communicable diseases. While adherence to particular rules and requirements may reduce the risk of possible exposure, the risk of serious illness and death remains; and 2. On behalf of my child and myself, I knowingly and freely ASSUME ALL SUCH RISKS, both known and unknown, even if arising from the negligence of the Releasees or others, and assume full responsibility for my participation; and 3. On behalf of my child and myself, I agree to comply with all rules, regulations or conditions established by Dayton Sports Complex and the State of Ohio for participation in such events or activities. If, however, I observe any violation of the rules, regulation or conditions established by Dayton Sports Complex or the State of Ohio during my presence or participation, I shall remove myself from participation and immediately bring such matter to the attention of the staff of Dayton Sports Complex; and 4. On behalf of my child and myself, I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Dayton Sports Complex, its officers, officials, agents, employees, Members, Leagues and Associations, clubs, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event or activity in which I participate (“RELEASEES”), from and against any and all claims of whatever type or kind including any illness, disability, death, or other loss or damage to person or property, whether arising from the negligence of Releasees or otherwise to the fullest extent permitted by law. Further, I expressly agree that this release is intended to be as broad and inclusive as permitted by the laws of the State of Ohio or any other state in which my/our child may participate in any event or activity described herein, and that if any portion of this release is determined to be invalid, it is agreed that the remaining provisions of this release shall continue in full force and effect. Finally, I further state that I have fully and carefully read the above release, understand the contents of the same and sign this release voluntarily and as my own free act and deed. I HAVE READ THIS RELEASE OF LIABILITY, HOLD HARMLESS AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I, ON BEHALF OF MY CHILD AND MYSELF, HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Discount Code (ENTER BEFORE CHOOSING PROGRAM OPTION)Choose a Program *Please Choose OneWinter 1 Soccer Academy Clinic (includes taxes and fees) - $ 130.00Winter 2 Soccer Academy Clinic (includes taxes and fees) - $ 130.00BOTH: Winter 1 & 2 Soccer Academy Clinic (includes taxes and fees) - $ 233.00Please Choose One *Please Choose OneTuesdaysThursdaysChild's First Name *Child's Last Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade *Please Choose OnePre-KK12345678School *Gender *Please Choose OneFemaleMaleParent/Guardian Name *FirstLastParent/Guardian Email *EmailConfirm EmailParent/Guardian Cell Phone *Comments/Additional Notes/Team Request (not guaranteed)PayPal Commerce *This page is not secure. 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