Arena Soccer Registration

Date ______________

Fullerton Family YMCA

Team Name: ________________ Manager: ______________________

Name ___________________________ Birth Date _____________ Age ____ Telephone #______________________ Cell # _________________________ Address ________________________________________________________ City/State/Zip____________________________________________________ E-Mail Address _______________________ Work #_____________________ Emergency Contact ____________________ Telephone # ________________ I am the manager of the team yes no
Circle all that apply: LEAGUE: Mens SEASON:

Womens Spring 25+/30+ Summer 35+

Co-Ed Fall

Winter 18+

AGE GROUP:

I hereby give consent to the YMCA of Orange Countys use of video or still images of my spouse, family, and myself for promotional purposes. Yes No Method of PaymentTeam Managers Only

Paid by: Cash

Check#______ Visa

Master Card

American Express

Discover

Card Number__________________________________ Expiration Date_______________ Name on Card_____________________ Authorized Card Signature___________________

Office Use: Received by: ________________ Date: _________ Processed by: _________________ Date: _______

2000 Youth Way, Fullerton, CA 92835 Telephone: (714) 879-9622 Fax: (714) 879-2820 Website: www.ymcaoc.org or e-mail Andrea at aberryman@ymcaoc.org

Fullerton Family YMCA Adult Soccer Agreement

Rules and Code of Conduct

If a team cannot field a full team, please notify the YMCA at least 48 hours prior by written notification or e-mail to aberryman@ymcaoc.org. The fee for cancellations/forfeitures with at least 48 hours notice given will be $25.00. If a team gives less than 48 hours notice of cancellation, or forfeits, the charge will be $50.00. This will be strictly enforced. All schedule requests need to be submitted in writing on or before the managers meeting. Once the schedule is made there will not be any changes or rescheduled games. NO EXCEPTIONS!!! Fullerton Family YMCA Arena Soccer Rules Apply. RED CARDS A player who receives a red card must leave the field and will miss the following game. o The team will serve a 5-minute penalty with no substitution. o NO appeals on red cards. YELLOW CARDS Player must sit out for 4 minutes (no substitution allowed) or until a goal is scored. BLUE CARDS- Player must sit out for 2 minutes (no substitutions allowed) or until a goal is scored. Fighting Players will be removed from the league. NO EXCEPTIONS!!! Abusive language towards teammates, referees, opponents, or spectators will NOT be tolerated and the player will be carded or possibly removed from the league. The YMCA reserves the right to remove a player at any time. No alcoholic beverages or tobacco use permitted. All players, managers/coaches, spectators and referees are expected to display good sportsmanship at all times. Team and Player Responsibilities

All players must be registered through the YMCA and have a current waiver and Code of Conduct signed in order to play and be on the scorecard. Teams playing an unregistered player will be removed from the league without refund. Each player must bring valid LICENSE or ID CARD to each game and check in with the YMCA staff to play. Players or Managers are not allowed to write in names on the roster. All players must be age appropriate for the division. NO EXCEPTIONS!!! Teams are not allowed to borrow players from other teams. All teams must have a uniform that includes shirts (permanent number and same color), socks, and shin guards. No jewelry may be worn during games. All trash must be picked up or it will incur a fee. Cheating on a registration form is prohibited. If caught, the player and manager will be removed, and possibly the team, without refund.

I understand that I am participating in a physical sport that involves competition between teams and I will not hold the YMCA responsible for the actions or lack of sportsmanship of other players in the league. I have read the Fullerton Family YMCA Arena Soccer Rules and above Code of Conduct and agree to abide by the Agreement of Understanding. Print Name: _____________________________ Signature: __________________________________ Date: ________________ *PLEASE KEEP A COPY FOR YOUR RECORDS

YMCA OF ORANGE COUNTY RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
Adult Member/Participant Name (Please Print) _____________________________________________ IN CONSIDERATION of being permitted to enter the YMCA for any purpose, including but not limited to observation, use of facilities or equipment, or participation in any way, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering will, inspect such premises and facilities. It is further warranted that such entry into the YMCA for observation, participation or use of any facilities or equipment in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment there on and such affiliated program have been inspected and carefully considered that the undersigned finds and accepts same as being safe and reasonably suited for the purposes of such observation or use. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION, USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH THE YMCA, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND

CONVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents (hereinafter referred to as releasees) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein or participants in any program affiliated with the YMCA.

2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND

HOLD HARMLESS the releasees and each of them from any loss, liability, damage or cost they may incur due to the presence of the undersigned in, upon or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releasees or otherwise.

3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR

AND RISK OR BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasee or otherwise while in, about or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMINTY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducement apart from the foregoing written agreement have been made. I HAVE READ THE RELEASE Signature ________________________________ Date _________________