Kensington Soccer Club 2022/23 Winter Recreation Registration Form

Thank you for your interest in recreational soccer with KSC! We are excited to see you out on the court for the 2022 - 2023 season.

Kensington Soccer Club operates on a pay-what-you-can basis. We believe high quality, fun soccer programming should be available to ALL, regardless of ability to pay.

At the end of this registration, you will be asked how much you are able to pay. Kensington Soccer Club will never inquire about this amount or share this information, we simply ask that you contribute what you are able.

We are also now happy to offer payment plans via PayPal. These include an option for $15/week as well as $50/month. In order to access these plans you will need to log in with a PayPal account. If you would like to pay via an installment plan but cannot log into PayPal, please reach out to us at admin@kensingtonsoccer.org for assistance.

Any questions regarding programming should be sent to Carlos Acosta at carlos@kensingtonsoccer.org or Tim Summiel at tim@kensingtonsoccer.org.

Thank you and welcome to the club!

Player Information

Parent/Guardian Information

Emergency Information

In case parent/guardian cannot be reached, please enter the name and contact information for at least one other emergency contact.

Media Release: In consideration of the opportunity to participate in the KSC program, I hereby give permission to KSC, its employees, affiliates, representatives, contractors, agents, and members of the media to interview, audiotape, videotape, film, or capture by any other electronic means my child's image, voice, and likeness, and, within its absolute discretion, to release, disseminate, or use, in any manner KSC sees fit including publications and web pages, the resulting images and testimonials and any other information contained therein for the purpose of demonstrating, advertizing, and promoting the objectives of KSC. I understand that my child and I shall receive no compensation for his/her appearance on or participation in the KSC prgram. As parent/guardian of minor, I hereby assign to KSC, all rights, including copyright, in any works created in whole or part by the minor while participating in the KSC program.

You can select "no" below and still register. If you select no, we will try our hardest to not include your child in any photographs or videos taken at soccer, but we cannot guarantee it.

Permission Waiver: As a parent or legal guardian of the minor listed on this form, I give permission for him/her to participate in Kensington Soccer Club (KSC). I understand that this permission includes my permission for my child to participate in all KSC activities. I understand that KSC assumes no responsibility for seeing to it that the minor reports to activities at the KSC sponsored program, and I, on my own behalf and on the behalf of this minor, waive all claims for any liability arising or actions occurring before or after the minor has reported to KSC programs. I give permission to KSC to collect and record data about my child for program evaluation purposes. I give permission to KSC to periodically survey my child for feedback and program evaluation purposes. I understand that all information obtained will remain private, and that any responses publicly reported will be grouped together with other participants. My child's identity shall be kept completely confidential when reporting. I also give my permission for KSC to provide transportation for my child to scheduled practices, games, tournaments, and other field trips.

Liability Release: I, the parent/guardian of the minor, agree that I and the minor will abide by the rules of KSC and its affiliated organizations and sponsors. My child has received a physical examination and has been found physically capable of participating in the KSC program. Recognizing the possibility of physical injury associated with soccer and physical activity and in consideration for KSC accepting minors for its program, I assume all risks and hazards incidental to athletic participation and hereby release, discharge, and/or otherwise indemnify KSC, its officers, directors, coaches, sponsors, volunteers, agents, and affiliates, against any claim by or on behalf of the minor as a result of the minor's participation in the KSC program.

Consent for Medical Treatment of Minor: In the event of a medical emergency, I hereby authorize the adult representatives of KSC to make any necessery arrangements for the proper medical care of the participating minor. I understand that I will be notified as soon as possible in the event that an emergency arises requiring medical assistance and I assume all financial responsibility for any medical treatment including transportation for my child.

Player After-Soccer Responsibility: I assume full responsibility for ensuring my child gets home safely after practices and games. If my child is not getting home on their own, I will be there at the end of practices and games to pick up my child.

Possible Transition to Virtual: I understand that in-person sessions may need to switch to being run virtually in the case of illness, exposure, or excessive disregard for safety guidelines. I understand that in that case a refund will not be issued because KSC still has to pay coaches and administrators to run the virtual program.

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate in athletic programming, sanctioned activities and events (collectively “Sanctioned Activities”) related to the Kensington Soccer Club, (“Releasee”) the undersigned acknowledges, appreciates, and agrees that:

1. Participation in such Sanctioned Activities inherently includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH INHERENT RISKS, both known and unknown, EVEN IF ARISING FROM THE ACTIVE OR PASSIVE NEGLIGENCE OF THE RELEASEE or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation in such Sanctioned Activities as regards to protection against infectious diseases. If, however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Releasee their officers, directors, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the Sanctioned Activities , WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE ACTIVE OR PASSIVE NEGLIGENCE OF RELEASEE OR OTHERWISE, to the fullest extent permitted by law. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby agree to defend and indemnify RELEASEE for all such claims, causes of actions, allegations or matters arising out of, relating to, based upon or in any way connected to my participation in such Sanctioned Activities.

5. I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I, for myself, my spouse, and child/ward, do consent and agree to his/her release provided above for all the Releasee and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasee for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.

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.

I hereby grant my child permission to participate in the KSC program and affirm that my child is without any physical or medical conditions that would prevent my child from engaging safely in physical activities.