World Cup Indoor Soccer-Futsal Individual Registration

SESSION THREE SUBMISSIONS - BY February 29, 2024

Session III dates:

World Cup (youth):March 2, 9, 16, 23, 31 & April 6, 13, 20
CoEd (adult): March 4, 11, 18, 25, & April 1, 7, 15, 22

THE SUBMISSION DEADLINES ARE FIRM. NO SUBMISSIONS AFTER THE DEADLINES WILL BE ACCEPTED.

You will receive a verification e-mail from ISA ( International Soccer Academy / Paypal ) upon completing this application. Please go over everything carefully.

BSC is not responsible for any missed sessions due to COVID-19 interference.

All online registration prices include a 3.5% credit card convenience fee.

-BSC Staff

Athlete Information

Athlete's Name*

First NameLast Name

Age Division*

Birth Date*

MonthDayYear

Gender*

MaleFemale

Select Payment*

Session 3 Individual Player Registration ( U8, U10, U12, U14, U16, Men's Open, Open Coed ) $120.00

Session 3 Individual Player Registration ( U8, U10, U12, U14, U16, Men's Open, Open Coed ) 5$120.00

7:00 pm- 8:30 pm (ADULTS ONLY) seven to eight weeks MANCHESTER ONLY

Session 3 Individual Player Registration ( U8, U10, U12, U14, U16, Men's Open, Open Coed ) 5$120.00

8:30 pm - 10:00 pm (ADULTS ONLY-BENNINGTON GROUP) seven to eight weeks

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Medical Release and Authorization

Bennington Sports Center Waiver and Release Form

Please Read Carefully

In consideration for me being permitted to participate in the Bennington Sports Center/Vermont Voltage Indoor Soccer Leagues and Fall / Winter Indoor Skills Training with the Bennington Sports Center/Vermont Voltage ("Event") at Bennington Sports Center ("Location"):

I understand the nature of the Event and I can safely participate in the Event. I am fully aware of the risks of unexpected injuries, damage, or other loss that may result from my attendance at and participation in the Event. I freely assume all such risks including the risk of any negligence by other participants, the Bennington Sports Center, Vermont Voltage, VT Premier Suites, and any of the organizers or volunteers of the Event or any of the other Released Parties as defined below. In connection with any injury, I may sustain or other medical conditions I may experience during my participation in or attendance at the Event I authorize any emergency medical treatment if needed.

I do hereby for myself, my heirs, and assigns, release from liability, waive any claims against, forever discharge and hold harmless the Bennington Sports Center, Vermont Voltage, VT Premier Suites, the owner(s), and the lessor(s) of the location, and each of their respective affiliated companies or other organizations, volunteers associated with the Event, the organizers of the event, and each of their respective officials, owners, partners, directors, officers, trustees, members, employees, representatives and agents, and the other participants in the Event (collectively, the "Released Parties") of and from any and all claims for injuries, disability, death, property damage, attorneys’ fees or other loss of any kind or nature that may be sustained in connection with my attendance at or participation in the Event or any activity surrounding the Event. I further agree not to sue any of the Released Parties for any such claim.

Publicity Release: I authorize the Bennington Sports Center, Vermont Voltage, VT Premier Suites, and/or the other parties involved with the Event to produce, reproduce, broadcast, and otherwise use photographs, films, videotapes, recordings, digital images, and other depictions, likenesses or images of me, in any media form, worldwide, in connection with my attendance at or participation in the Event without compensation, for an unlimited duration.

Due to COVID-19:
Anyone showing signs of respiratory illness will need to stay home from classes/practices. This includes, but is not limited to fever, coughing, shortness of breath, etc.

Masking indoors is encouraged for all who desire but at each one's discretion and subject to change at any time to remain consistent with VT Dept of Health and CDC recommendations.

BSC is not responsible for any missed sessions due to COVID-19 interference.

I, intending to be legally bound, have carefully read and voluntarily agreed to this Waiver and Release and I understand its full legal effect.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

On completion of this application you will recieve a verification e-mail from ISA ( International Soccer Academy / Paypal ). Please go over everything carefully.

All online registration prices include a three percent credit card convenience fee.

-BSC Staff

Signature*

World Cup And Indoor Soccer-Futsal INDIVIDUAL Registration Form

Please note that this form is for individual registration only. If you do not have a team, and would like to be placed on one please continue filling this form out. Payment can be completed at the end once you finish filling this form out. Thank You - Bennington Sports Center Staff