Soccerland Opalocka

SOCCERLAND OPALOCKA FORM

PERSONAL DATA: Participant

First Name

Last Name

Age

Date of Birth

Sex

Address

FAMILY DATA:

Father's name

PHONE NUMBERS:

Phone

Ofi

Mobile

Mother's name

PHONE NUMBERS:

Phone

Ofi

Mobile

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(No participant could be withdrawn if the person is not authorized in this form)

MARK THE WEEKS IN WHICH YOUR REPRESENTATION WILL PARTICIPATE

Checkbox Field

SPRING BREAK

SUMMERCAMP

MEDICAL RECORD

Does the child have a physical disability or illness?

Is the child allergic to any medication and/or food?

Does the child take some type of medication?

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

GENERAL CONDITIONS

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. The accessories that the parents deem convenient to send for the well-being of their representative, must be notifyed in writing to the Management of the Summercamp. Still, we will not be responsible for those, nor for the money that the campers carry.

3. It is strictly mandatory, that each camper brings all his clothing identified with his name, both the uniform and other accessories. This mark must be placed on the inside of it.

4. The parents and (or) guardian, will be able to observe the activities that the children realize, as long as they do not interfere with it.

5. The parents and (or) guardian will be strictly forbidden to exceed the safety limits established by the staff of the summercamp in the different areas such as: dining room, fields, special activities, swimming pools, among others.

6. Once the payment is made, the parents and (or) guardian will not be entitled to the refund of the money. Under no circumstances (this includes absence due to illness, suspension due to inappropriate behavior, problems of adaptation, if you arrived late to the fieldtrip departure or any other reason).

7. The Parents and (or) guardian must inform the Summercamp Organizing Committee in writing, the contraindicated medications for the campers, as well as their medical history, allergies and any other information considered necessary and indispensable in case of an emergency.

8. The parents and (or) guardian will accept that any other expense that derives from illness or accident of the camper, not covered by the referred policy must be paid by them.

9. The parents and (or) guardian will accept that the admission and permanence of the campers within the camp is subject and expressly conditioned to it complying with all the rules, policies (conditions), and camp order practices.

10. The participant will not be allowed to attend the weekly fieldtrip if he does not bring the summercamp uniform. Under no circumstances will it be allowed, for reasons of extreme security.

11. Under no circumstances will children be received at the place of the fieldtrip, if the camper does not arrive at the scheduled time to leave. If the minor does not attend the fieldtrip, he should be taken to the facilities of the summercamp only when the rest of the group arrives.

12. The distribution of the children will be made by age groups and level of development that in the opinion of the summercamp manager is considered for the shelter of the camper and the group. Under no circumstances may parents interfere in this decision.

13. Under no circumstances will the campers be allowed to enter the summercamp without their representative.

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

15. The Summercamp will be responsible for its representative starting at 8:00 a.m. until 5:00 p.m. The permanence of the same in the camping outside the established schedules, will cause a fine of $ 10 for every 15 minutes of delay.

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: