Starmount T1

Registration Form
Class Name
Status
Location
Submission ID*
Thank you for being a part of Soccer FC this season! We are so excited to have your child on the team. To enroll your child in the program please complete the form below. If you have more than one child participating in Soccer FC, please fill in the form once for each child.

In this registration, you will be asked some questions about yourself and your child that help us to design the program and ensure its greatest impact.

To navigate between pages, please use the "Next" and "Prev" arrows at the bottom of the page. Using the "back" button on your browser will reload the page and may lose any information you've entered.

**You must complete all questions and select "done" on the final page for your child to be enrolled in Soccer FC**
Our registration is full, however, you can be added to our waitlist and notified if a spot opens up. To join the waitlist please complete the questions below.

Emergeny and Pickup Contact Information

Please list those other than yourself who may care for your child
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Confirm Emergency Contact Phone Number*
Please enter a valid phone number.
Authorized Pickup Person*

First NameLast Name
Authorized Pickup Person Phone Number*
Please enter a valid phone number.
Confirm Authorized Pickup Person Phone Number*
Please enter a valid phone number.
Is there a parent or relative we should NOT release your child to?

First NameLast Name
Additional Pickup Person for this Season

First NameLast Name
Additional Pickup Person Phone Number
Please enter a valid phone number.
ARRIVAL & DISMISSAL POLICY:

Parents are expected to arrive a few minutes before the session is complete. If your child is to be picked up by someone other than yourself, please note the authorized pickup person on the registration. Arriving late to pick up your child can result in your child being removed from the Soccer F.C. program.
Agreement*

I agree to the above policy

Additional Information

Please answer the following questions honestly; there are no right or wrong answers. We are not looking for specific answers, so put what is true for you and your child.
How often do you or others at home read to your child? *
About how many books do you have in the house for your child?*
How comfortable are you with reading English?*

Additional Questions

The following questions are about your child. The first set asks about your child reading. Please select how much you disagree or agree with the following statements about your child.
My child likes reading*

1 star = strongly disagree, 5 stars = strongly agree
My child is good at reading*

1 star = strongly disagree, 5 stars = strongly agree
My child reads on their own*

1 star = strongly disagree, 5 stars = strongly agree

Additional Questions

The following questions are about your child. They ask about how you see your child. Please select how much you disagree or agree with the following statements about your child. Remember, there are no right or wrong answers; we want to know what is true for your child.
My child will be successful in their future*

1 star = strongly disagree, 5 stars = strongly agree
My child is happy with who they are*

1 star = strongly disagree, 5 stars = strongly agree
My child puts effort into anything they do*

1 star = strongly disagree, 5 stars = strongly agree
Consent
I consent to Charlotte-Mecklenburg Schools releasing the following data for my child to Soccer FC for the purposes of monitoring student progress. This consent remains in effect until notification from a parent or legal guardian is received by this agency notifying the agency to discontinue services and program involvement or the student no longer is receiving services for any reason.

Demographic data (that is, gender, race/ethnicity, grade level, school name)
Limited English Proficiency (LEP) Status
Exceptional Children (EC) and/or Gifted (AIG) Status
Course Grades
Standardized Test scores, levels, proficiency (that is, beginning, middle, and end of year district and state tests)
Attendance Data
Behavior data (suspensions)
Promotion/Retention
Parent/Guardian Signature to release data for monitoring student progress

Clear
I consent to Charlotte-Mecklenburg Schools releasing the previously stated data for my child to Executive Leadership Partners for the purposes of conducting a program evaluation of Soccer FC. This consent remains in effect until notification from a parent or legal guardian is received by this agency notifying the agency to discontinue services and program involvement or the student no longer is receiving services for any reason.
Parent/Guardian signature to release data for program evaluation

Clear

WAIVER & RELEASE
Waiver and Release - Updated August 31st, 2021 Soccer F.C. Waiver and Release

WAIVER & RELEASE:

Agreement to Participate in Soccer F.C.

Participation in all sports can be inherently dangerous and it is impossible to ensure the safety of all participating individuals. Soccer demands cardiovascular fitness, coordination, and agility. Although many risks can be avoided, I understand that not all risks can be and release Soccer F.C. from responsibility for any injury that my child might incur during the course of normal play. I further understand that in the event of a medical emergency, Soccer F.C will call EMS to render assistance and that I will be financially responsible for any expenses involved.

While playing soccer, accidents do happen. Some of these accidents may be minor like collisions with other players, collisions with the ground, and being struck by the ball. Other accidents may be more significant like collisions with the goalposts. Other injuries may also include minor injuries like scrapes, bruises, strains, blisters, and sprains; more serious injuries like broken bones, concussions, muscle tears, and ligament tears; catastrophic injuries like heat stroke, cardiac arrest, and death.

To reduce the risk of injury, participants are expected to abide by the following rules: all participants are expected to be physically fit before Soccer F.C. begins all players must adhere to the rules of soccer, thus creating a safe playing environment.
The above-mentioned participant agrees to follow the preceding safety rules, all posted safety rules, and all rules common to the sport of soccer. Further, the above-mentioned participant agrees to report any unsafe practices, conditions, or equipment to the Soccer F.C. instructor.

I certify that the above-mentioned participant 1) possesses a sufficient degree of physical fitness to safely participate in soccer, 2) understands that he/she is to discontinue activity at any time he/she feels undue discomfort or stress, and 3) has indicated in the "Special Needs" section any health-related conditions that might affect his/her ability to play soccer and he/she will verbally inform the Soccer F.C. instructor immediately.

I have read the preceding information and it has been explained to me. I know, understand, and appreciate the risks associated with participation in soccer and I am voluntarily participating in the above-mentioned participant in the activity. In doing so, the above-mentioned participant is assuming all of the inherent risks of the sport.

I do hereby consent and agree that Soccer F.C. has the right to take photographs and videos of my child during soccer sessions. These photos and videos may be used on the company website (www.soccerfc.org), company Facebook pages, and promotional material without compensation. I understand that my child's name and identity will not be revealed. If you would prefer we not take photographs or video your child, please notify us via e-mail.

Waiver of Liability: In consideration of being permitted to play soccer, on behalf of myself, my family, my heirs, and my assigns, I hereby release Soccer F.C., its agents, and its employees from liability for injury, loss, or death to the above-mentioned participant while using any facility or equipment or in any way associated with participating in the activity of soccer now or in the future, resulting from the ordinary negligence of Soccer F.C., its agents and employees.
TELEPHONE, EMAIL, AND SMS TEXT MESSAGING TERMS AND CONDITIONS:
By clicking “I accept” you are consenting to receive email, text, WhatsApp and or phone communications from Soccer F.C. Message frequency varies.

Soccer F.C. does not have a separate charge for these services; however, message and data rates may apply from your mobile carrier for SMS text messages. Subject to the terms and conditions of your mobile carrier, you may receive text messages sent to your mobile phone.

By clicking “I agree” you are providing your consent to participate in this program, you approve any such charges from your mobile carrier. Charges for text messages may appear on your mobile phone bill or be deducted from your prepaid balance. Soccer F.C. reserves the right to terminate this SMS service, in whole or in part, at any time without notice. The information in any message may be subject to certain time lags and/or delays. You are responsible for managing the types of SMS texts you receive.

To stop receiving text messages, reply STOP, END, CANCEL or UNSUBSCRIBE to a Soccer F.C. SMS text message. By enrolling in this subscription program, you consent that following such a request to unsubscribe, you will receive one (1) final message from Soccer F.C. confirming that you have been inactivated in our system. Following such a confirmation message, no additional text messages will be sent unless you reactivate your subscription.

To stop receiving email messages or to manage your communication preferences, click on the Unsubscribe link contained in the Soccer F.C. email message.

By Unsubscribing from receiving SMS text messages and/or email communications, I acknowledge that I will no longer receive any communications including, emergency communications via SMS text messaging or email messaging.
Waiver & Release Acceptance*

I agree and accept the full Terms & Conditions
Should be Empty:

Registration Form

Register

Parent / Guardian Information

Waitlist Sign-Up

Participant Information

Emergeny and Pickup Contact Information

Additional Information

Additional Questions

Additional Questions

Consent

WAIVER & RELEASE