2023 Summer Camp

Goalie Camp

July 24th-28th 9:30-12:00 Pm

I am registering for the following camp:(Required)
Boys Age Group
Please select age and gender
Girls Age Group
Please select age and gender

PLAYER INFORMATION

Player information(Required)
Player date of birth
Player address same as Parent/Guardian #1?(Required)
Jersey Size(Required)
Preferred Playing Position (Required)
Please choose one

PARENT/GUARDIAN #1 INFORMATION

Parent/Guardian #1(Required)

PARENT/GUARDIAN #2 INFORMATION

Parent/Guardian #2

Essex International Select LLC (EIS)

WAIVER & RELEASE FORM

Because physical exercise can be strenuous and subject to risk of serious injury, the club urges you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity including but not limited to soccer, soccer drills, conditioning, speed and agility work. You (each member, guest, and all participating family members including minors in which you are the parent/guardian) agree that if you engage in any physical exercise or activity, or use any club amenity on the premises or off premises including any sponsored club event, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property. This waiver and release of liability includes, without limitation, all injuries which may occur as a result of, (a) your use of all amenities and equipment in the facility and your participation in any activity, class, program, personal training or instruction, (b) the sudden and unforeseen malfunctioning of any equipment, (c) our instruction, training, supervision, or dietary recommendations, and (d) your slipping, tripping, bumping, and/or falling while in the club, or on the club premises, including adjacent sidewalks and parking areas, (e) your participation in any classes and/or clinics that are organized at off-site locations. You acknowledge that you have carefully read this waiver and release and fully understand that it is a release of liability. You expressly agree to release and discharge EIS and all affiliates, directors, owners, employees, agents, representatives, successors, or assigns, from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the club for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of the Club, its agents, and employees. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally. I grant Essex International Select, LLC the irrevocable right and unrestricted permission to use and publish photographs or video images of my child, or in which my child may be included, for any purpose authorized by EIS, including but not limited to: website use, social media, editorial publications, catalog and advertising use. This grant includes the right to modify and retouch the images at the discretion of EIS. I understand that the circulation of such materials could be worldwide and that there will be no compensation to me for this use. Furthermore, I understand that I will not be given the opportunity to inspect or approve the finished products or the advertising copy or the printed matter that may be used in connection therewith. In granting this permission to EIS, I am fully and without limitation releasing it from any liability that may arise from the use of the images.

(Required)

Essex International Select, LLC (EIS).

COVID-19 PANDEMIC PLAYER CONSENT FORM

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 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. EIS has put in place preventative measures to reduce the spread of COVID-19; however, EIS cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending EIS events could increase your risk and your child(ren)’s risk of contracting COVID-19. I confirm that neither my child nor any one in my child’s household is presenting any of the following symptoms of COVID-19: fever (> 100.4 F), shortness of breath, loss of sense of taste or smell, dry cough, runny nose, sore throat. I further confirm that neither my child nor any one in my child’s household has been in contact with someone who has tested positive for COVID-19 in the last 14 days nor has my child nor in any one in my child’s household traveled outside of the United States in the past 14 days. Neither my child nor in any one in my child’s household is awaiting results for COVID-19 or antibodies. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending this event 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 EIS may result from the actions, omissions, or negligence of myself and others, including, but not limited to, EIS employees, Officers, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the event (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Essex International Select, LLC its employees, officers, coaches, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the EIS, its employees, agents, and representatives,whether a COVID-19 infection occurs before, during, or after participation in any EIS program.

(Required)

Essex International Select, LLC (EIS) Permission to Use

  1. I, hereby grant EIS the irrevocable right and unrestricted permission to use and publish photographs or video images of my child, or in which my child may be included, for any purpose authorized by EIS, including but not limited to: website use, social media, editorial publications, catalog and advertising use. This grant includes the right to modify and retouch the images at the discretion of EIS

  2. I understand that the circulation of such materials could be worldwide and that there will be no compensation to me for this use. Furthermore, I understand that I will not be given the opportunity to inspect or approve the finished products or the advertising copy or the printed matter that may be used in connection therewith. In granting this permission to EIS and its legal representatives, I am fully and without limitation releasing it from any liability that may arise from the use of the images.
(Required)