Sports Registration: Concordia Lutheran School Christ-centered

Sports/Extra-Curricular Registration

Which activity are you registering for? (w/Registration Fee)(Required)

Which activity are you registering for? (hidden-saved from previous update)

Please select a soccer category/level:(Required)

Please enter your current jersey #(Required)

New Soccer Jersey

If you already have a jersey you are not required to purchase a new one.

Price: $10.00

Please select a volleyball category/level:(Required)

Please select a cross country category/level:(Required)

Please select a golf category/level:(Required)

Please select a basketball category/level:(Required)

Please select a cheerleading category/level:(Required)

Please select a track category/level:(Required)

Student's Name(Required)

Student's Grade During Selected Activity(Required)

Parent/ Guardian Name (Primary)(Required)

Email(Required)

Phone Number(Required)

Parent/ Guardian Name (Secondary)

Phone Number

Who should be notified regarding activity schedules & updates?(Required)

Contact Primary only

Contact both Primary & Secondary

Emergency Medical Authorization

Purpose - to enable parents and guardians to authorize the provision of emergency for children who become ill while under school authority, when parents or guardians cannot be reached.

Participant Date of Birth(Required)

Participant Place of Birth(Required)

Please read & Confirm Below:(Required)

In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by my preferred doctor or dentist, or, in the event the designated preferred practitioner is not available, by another license physician or dentist; and (2) the transfer of the child to my preferred hospital or any hospital reasonably accessible.

Preferred Doctor(Required)

Preferred Dentist(Required)

Preferred Hospital(Required)

Student's Medical History(Required)

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery. Facts concerning the child's medical history including allergies, medications taken, and any physical impairments to which a physician should be alerted:

Insurance Carrier

Policy Number

PEORIA PAROCHIAL SOCCER LEAGUE RELEASE AND WAIVER OF LIABILITY FOR MINOR PARTICIPANTS(Required)

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

IN CONSIDERATION OF my aforementioned child/ward, being allowed to participate in any way in the Peoria Parochial Soccer League and any related events and activities, the undersigned acknowledges, appreciates, and agrees to the following:

I fully understand and acknowledge that my child/ward will be engaging in activities that involve serious risk of injury. I understand and acknowledge that the risk of injury to my child/ward from the activities involved in these programs is significant, including but not limited to the potential for concussion, other significant injuries, permanent disability and death; severe social and economic losses; and the incurring of medical bills. While particular rules, equipment, and personal discipline may reduce the risks, the risk
of serious injury does exist.

For myself, my spouse, my child/ward, and all of our collective heirs, assigns and personal representatives, I knowingly and freely relinquish, waive and otherwise discharge any all claims that may arise to me or my child/ward out of my child/ward’s participation in the Peoria Parochial Soccer League and all related events and activities. For myself, my spouse, my child/ward, and all of our collective heirs, assigns and personal representatives, I knowingly and freely specifically relinquish, waive and otherwise discharge any and all claims that I might have on behalf of myself or my child against the Peoria Parochial Soccer Association; the Catholic Diocese of Peoria and its schools, churches and parishes; each school/organization or member church that is a member of the Peoria Parochial Soccer League, the Peoria Park District and each respective entities’ officers, agents, servants, associates, directors, coaches, managers, volunteers, advertisers, sponsors and any owner or lessor of lands at which Peoria Parochial League games, activities or events are held. (hereinafter referred to as “Releasees”), even if such claims arise from the negligence of the Releasees.

For myself, my spouse, my child/ward and all of our collective heirs, assigns and personal representatives I assume all risks, both known and unknown, arising from the actions, inactions or negligence of my child, or the Releasees, and I further assume full responsibility for my child’s participation.

For myself, my spouse, my child/ward and all of our collective heirs, assigns and personal representatives I agree to indemnify, hold harmless and defend the Releasees for any claims, losses or lawsuits resulting from injuries of any kind caused by or to me, my spouse or my child/ward.

I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any
unusual, significant concern in my child’s readiness for participation in the Peoria Parochial Soccer League and its related events
and activities, I will remove my child from the participation and bring such attention of the nearest official immediately,
The novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. The Peoria Parochial Soccer League cannot guarantee that you will not become infected with COVID-19. Attending soccer games under the auspices of the Peoria Parochial Soccer League could increase your risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I, my spouse or children may be exposed to or infected by COVID-19 while participating in Peoria Parochial Soccer League games or activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Peoria Parochial Soccer League games or activities may result from the actions, omissions, or negligence of myself and others. By signing this agreement, I agree to indemnify, hold harmless and defend the Releasees for any claims, losses or lawsuits resulting from contraction of COVID-19 by
me, my spouse or my child/ward.

For myself, my spouse, my child/ward, and I acknowledge that the goal of the Peoria Parochial Soccer Association is to teach, foster and promote the sport of soccer, while providing participants with an opportunity to enjoy the sport and to improve playing skills. I further understand that the Peoria Parochial Soccer League promotes good sportsmanship and a Christian attitude. I understand that winning must never come at the expense of these fundamental objectives. I will strive to ensure that I, my spouse
and my child/ward behave and participate in a manner consistent with these objectives.

Participant Expectations and Permission Slip

I have filed a current physical examination in the school office.(Required)

Yes

Parent/Guardian eSignature(Required)

Participant eSignature(Required)

I understand that to participate in this sport I must comply with the regulations stated here and in the athletic handbook.

Payment

Registration Fee

$0.00

New Soccer Jersey (if selected)

$0.00

Subtotal

$0.00

How would you like to make your payment?(Required)

Cash/Check

Credit Card

Credit Card Fee

Price: $0.00

(2.9% + $0.30)

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Payment Notice

Please note that payment is required for your registration to be processed.