Soccerland Doral

SOCCERLAND DORAL FORM

DATOS DEL PARTICIPANTE

Nombre

Apellidos

Edad

Fecha de Nacimiento

Sexo

Dirección

DATOS FAMILIARES

Nombre del Padre

Correo electrónico

PHONE NUMBERS:

Teléfono

Oficina

Móvil

Nombre de la Madre

Correo electrónico

PHONE NUMBERS:

Teléfono

Oficina

PEOPLE AUTHORIZED TO PICK UP THE PARTICIPANT: (Place name and last name)

(No participant could be withdrawn if the person is not authorized in this form)

Marque el programa donde participará

Casilla de verificación

SPRING BREAK

SUMMERCAMP

HISTORIAL MÉDICO

¿Tiene el niño una discapacidad física o una enfermedad?

¿Es el niño alérgico a algún medicamento y/o alimento?

¿Toma el niño algún tipo de medicación?

Credit Card Authorization

Type of Credit Card:

Security Code

Name as it appears on the card:

Credit Card Number:

Expiration Date

Phone Number of Cardholder

Billing Address of Cardholder

I authorize that the debit be made according to the program.

Date

Condiciones generales

1. Summercamp / Springbreak will not allow objects or appliances that are not requested or required in the registration form or in any communication specially issued in this regard therefor the organization will not be responsible for the loss or total or partial damage of any of the objects described above and will not be at any time cause for complaint by Parents or Guardian.

2. Los accesorios que los padres estimen conveniente enviar para el bienestar de su representado, deberán ser notificados por escrito a la Dirección del Summercamp. Aún así, no nos haremos responsables de los mismos, ni del dinero que lleven los campistas.

3. Es estrictamente obligatorio, que cada campista traiga toda su ropa identificada con su nombre, tanto el uniforme como otros accesorios. Esta marca debe colocarse en el interior de la misma.

4. Los padres y (o) el tutor, podrán observar las actividades que realicen los niños, siempre y cuando no interfieran con ello.

5. Los padres y (o) el tutor tendrán estrictamente prohibido sobrepasar los límites de seguridad establecidos por el personal del campamento de verano en las diferentes áreas como: comedor, campos, actividades especiales, piscinas, entre otras.

6. Una vez realizado el pago, los padres y (o) el tutor no tendrán derecho a la devolución del dinero. En ningún caso (esto incluye la ausencia por enfermedad, la suspensión por comportamiento inadecuado, los problemas de adaptación, si se llega tarde a la salida del viaje de campo o cualquier otro motivo).

7. Los padres y (o) el tutor deben informar por escrito al Comité Organizador del Campamento de Verano, los medicamentos contraindicados para los campistas, así como su historial médico, alergias y cualquier otra información que se considere necesaria e indispensable en caso de emergencia.

8. Los padres y (o) el tutor aceptarán que cualquier otro gasto que se derive de la enfermedad o accidente del campista, no cubierto por la referida póliza deberá ser pagado por ellos.

9. Los padres y (o) el tutor aceptarán que la admisión y permanencia de los campistas dentro del campamento está sujeta y expresamente condicionada a que cumpla con todas las normas, políticas (condiciones) y prácticas de orden del campamento.

10. El participante no podrá asistir a la excursión semanal si no trae el uniforme del campamento de verano. En ningún caso se permitirá, por razones de extrema seguridad.

11. En ningún caso se recibirá a los niños en el lugar de la excursión, si el campista no llega a la hora prevista para salir. Si el menor no asiste a la excursión, deberá ser llevado a las instalaciones del campamento de verano sólo cuando llegue el resto del grupo.

12. La distribución de los niños se hará por grupos de edad y nivel de desarrollo que a juicio del director del campamento de verano se considere para el resguardo del campista y del grupo. En ningún caso los padres podrán interferir en esta decisión.

13. En ningún caso se permitirá a los campistas entrar en el campamento de verano sin su representante.

14. It is mandatory that parents sign the children’s attendance on a daily basis both at the entrance and at the exit.

15. El campamento de verano se encargará de su representante a partir de las 8:00 horas hasta las 17:00 horas. La permanencia del mismo en el camping fuera de los horarios establecidos, dará lugar a una multa de 10 dólares por cada 15 minutos de retraso.

16. As a parent / legal guardian I authorize Soccerland Park and PV International Sport Kids to use and display the images in which my minor appear in activities, competitions, etc. carried out within their facilities or in which they attend with the same, and the companies may published on social networks.

NAME OF PARENT

Date / Time

NAME OF PARTICIPANT

DATE OF BIRTH

NOTICE TO THE MINOR CHILD’S / NATURAL GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF DORAL SOCCERLAND LLC and P&V INTERNATIOAL SPORT KIDS. USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM DORAL SOCCERLAND LLC and P&V INTERNATIOAL SPORT KIDS. IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND DORAL SOCCERLAND LLC and P&V INTERNATIOAL SPORT KIDS. HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

IN CONSIDERATION of being permitted to participate in any way in Doral Soccerland program activity (“Activity” Activities include, but are not limited to: Camps, birthday parties, rentals, leagues and special events.) I, for myself for personal representatives, assigns, heirs, and next of kin:

1. ACKNOWLEDGE, agree, and represent that I understand the nature of Doral Soccerland LLC. program Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.

2. FULLY UNDERSTAND THAT: (a) Doral Soccerland program ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inaction’s, the actions
or inaction’s of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Doral Soccerland LLC, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity
takes place, (each considered one of the "RELEASES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

SIGNATURE OF PARENT

Phone:

Address:

City:

State:

Zip:

Email:

Signature

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