Matthew Hoppe Foundation Camp Registration 2024

Participant's Name*

First NameLast Name

Email Address*

Phone Number*

Please enter a valid phone number.

Date of Birth*

Under 18 Years Old?*

YesNo

Gender*

MaleFemale

Position*

Goalkeeper (Goalie)Field Player

Please list any allergies (food, environmental, medications etc)

Any conditions that we need to be aware of?

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone*

Please enter a valid phone number.

Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Select T-Shirt Size*

Liability Waiver

I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if the Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant(or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.

Do You Agree to Liability Waiver?*

Yes, I agree

Photo Release Form

The Matthew Hoppe Foundation PHOTO RELEASE FORM

I hereby grant the Matthew Hoppe Foundation permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of the Matthew Hoppe Foundation and will not be returned.

I hereby irrevocably authorize the Matthew Hoppe Foundation to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge the Matthew Hoppe Foundation from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW.

Do You Agree to Photo Release Form?*

Yes, I agree

BY SIGNING MY NAME BELOW, I HEREBY ACKNOWLEDGE AND REPRESENT THAT I AM AT LEAST 18 YEARS OF AGE OR OLDER, THAT I HAVE READ THIS ENTIRE DOCUMENT, THAT I UNDERSTAND ITS TERMS AND PROVISIONS, THAT I UNDERSTAND IT AFFECTS MY LEGAL RIGHTS, AND THE RIGHTS OF MY CHILD, THAT IT IS A BINDING AGREEMENT, AND THAT I HAVE SIGNED IT KNOWINGLY AND VOLUNTARILY.

Signature Here*

Any Comments or Questions?

Registration Fee*

Camp Registration

$150.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration