Black Stone FC

Fees are required to paid on the first of each month.*

*THERE IS A LATE PAYMENT FEE OF $10 FOR PAYMENTS MADE AFTER THE 15TH OF THE MONTH.

Payments can be made electronically through Zelle, Cash App or PayPal to:

Janet Hutchinson 407-288-0645.

Please state your name, your payment plan eg 1,2, or 3 players or volunteer, and the month for which you are paying.

I, the parent or legal guardian of the above named child(ren) participant(s), recognize the possibility of physical injury associated with the sport of soccer, and hereby release, discharge, and otherwise indemnify the soccer club, hereby recognized as Blackstone Football Club or Blackstone FC, their staff, sponsors, or any affiliated organizations, as well as the employees and associated personnel of these organizations, against any claim by or on behalf of the above named child(ren) participant(s) as a result of any injury sustained at any time during their willing participation in a Blackstone FC scheduled event or activity, and/or while being transported to or from the same, for which I also grant authorization.  I give permission for my child to be trained in the use of "heading" the soccer ball as it is common practice in the sport.  I give consent for the above named child(ren) participant(s) to be instructed and supervised by adult coaches, club-authorized assistants, club-authorized volunteer parents, etc. Given the risks involved as aforementioned, and knowing the possibility of an event resulting in physical injury or emergency, I hereby give my consent to have the head coach, or any assistant coach, athletic trainer, and/or team manager to administer basic first aid emergency care to the above named child(ren), a willing participant(s) of Blackstone Football Club.  In such an emergency, I also authorize for any immediate treatment to be performed by a qualified medical technician (EMT), nurse, medical treatment facility, and/or Doctor of Medicine or dentistry, or any other qualified medical personnel to provide the above named participant(s) with immediate medical assistance and/or treatment. In the event of a medical emergency, I agree to the use of participant's personal health insurance to used and be financially responsible for any additional cost resulting from such assistance and/or treatment. I also hereby authorize the use of emergency transportation to transport the above named child(ren) participant to the nearest medical treatment facility should a member of the club's leadership listed above consider it to be warranted.