UFCA Winter 2026 Registration

UFCA Winter 2026 Registration

Wicket, Lombard, IL
How many kids are you signing up?*
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Does your child have any allergies?*
Please provide details of the allergies
Does your child have any health conditions?*
Child 1 Name*

First NameLast Name
Child 1 Date of Birth*

MonthDayYear
Date
Does child 1 have any allergies?*
Please provide details of child 1's allergies
Does child 1 have any health conditions?*
Child 2 Name*

First NameLast Name
Child 2 Date of Birth*

MonthDayYear
Date
Does child 2 have any allergies?*
Please provide details of child 2's allergies
Does child 2 have any health conditions?*
Child 3 Name*

First NameLast Name
Child 3 Date of Birth*

MonthDayYear
Date
Does child 3 have any allergies?*
Please provide details of child 3's allergies
Does child 3 have any health conditions?*
Child 4 Name*

First NameLast Name
Child 4 Date of Birth*

MonthDayYear
Date
Does child 4 have any allergies?*
Please provide details of child 4's allergies
Does child 4 have any health conditions?*
Parent/Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com

PHOTO RELEASE

I hereby authorize Ummah FC Academy to publish the photographs taken of me and/or the minor children listed below, and our names, for use on the Ummah FC Academy social media platforms. I release Ummah FC Academy from any expectation of confidentiality for the minor children and myself and attest that I am the parent or legal guardian of the child or children listed below and that I have the authority to authorize Ummah FC Academy to use their photographs. I acknowledge that since participation in publications and websites produced by the Ummah FC Academy is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by Ummah FC Academy confers no rights of ownership whatsoever. I release, Ummah FC Academy, its officials, agents, volunteers, contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the minor child or children listed below.
Photo Release Agreement*
MEDICAL RELEASE FORM

THIS AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT MUST BE COMPLETED BEFORE PARTICIPANT (PLAYER/ COACH/ REFEREE) CAN PARTICIPATE IN ACTIVITIES. TREATMENT FOR INJURY WILL BE BASED ON INFORMATION PROVIDED HEREIN.

I the undersigned participant and parent/guardian of the above listed minor (if participant is under the age of 18) acknowledge and fully understandthat each participant will be engaging in activities that involve risk of serious injury, including permanent disability or death, and severe social and economic losses which might result not only from their own actions, inactions or negligence, but action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used and further, that there may be other unknown risks not reasonably foreseeable at this time, assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death, hereby release, discharge, covenants to indemnify and not to sue Ummah FC Academy, its officers, employees, coaches, managers, agents, sponsors and associated personnel including those of its affiliated organizations, and the owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as 'releasees', from any and all liability to each of the undersigned his/her heirs or next of kin for any and all against any claim by or on behalf of the applicant as a result of the applicant's participation in the Programs and/or being transported to or from the same, which participation after careful consideration I hereby authorize, and which transportation Thereby authorize. The applicant/participant has received a physical examination by a physician and has been found physically capable of participating in the Programs. I hereby give my consent to have an athletic trainer, coach and/or doctor of medicine or dentistry or associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I also agree to save and hold harmless and indemnify each and all parties herein referred to above as releasees from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said releasees because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the releasees. I have read the above waiver/release and understand that (I) we have given up substantial rights by signing this release and sign below voluntarily. I understand that this document may not be altered in any manner and that any alternation without the express written consent from the Ummah FC Academy will cause the participant to be removed from the Program.
Medical Release and Liability Agreement*
Emergency Contact Name and relation to the child*
Emergency Contact Phone*
Please enter a valid phone number.
Medical/Hospital Insurance Company
Date Signed*

MonthDayYear
Date
Parents/Guardians' Signature*

Clear

WICKET TERMS AND CONDITIONS

Please agree to the following terms and conditions:

In consideration of myself and/or child and/or legal guardian being permitted to participate in any way in any activity at Wicket Corp., including, but not limited to, lndoor Cricket, ("Activity") or any other activity permitted by Wicket Corp. I, on behalf of myself, my child, my legal guardian, my personal representatives, assigns, heirs, and next of kin:

Acknowledge, agree, and represent that I understand the nature of the Activity and that myself and/or child and/or legal guardian is qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time myself and/or my child's and/or my legal guardian's ability to continue to engage in such Activity, I will immediately discontinue myself and/or child's and/or legal guardian's further participation in the Activity.
Fully understand that:The activity involves risks and dangers of serious bodily injury, including permanent disability, paralysis, and death ("Risks")
These Risks and dangers may be caused by myself and/or child's and/or my legal guardian's own actions or interactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the "Releasees" named below.
There may be other risk and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages myself and/or child and/or legal guardian may incur as a result of his/her participation in the Activity.
I agree to assume the full risk of injuries, including death, damages, illness or loss which I may sustain as a result of participating in any and all Activities and programs of Wicket Corp..
Hereby Release, discharge, and covenant not to sue Wicket Corp. and all of its affiliated companies, its respective administrators, directors, agents, officers, managers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place, (each considered on of the "Releasees" herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the "Releasees" or otherwise, including negligent rescue operations, whether such liability would otherwise result in loss or damages to myself, my child, my legal guardian or the respective personnel representative, heirs or next of kin, and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.
Use Permission. I also give Wicket Corp. or Wicket Corp.'s third party operators and their agents and designees permission to use or distribute, without limitation or obligation, my image, name, voice, and words for any purpose connected with the Activity, including promotional, marketing, training, informational, and archival uses.
Code of Conduct.Â As consideration for permission to use the premises, to participate in Activities at Wicket Corp., and to use any of Wicket Corp.'s facilities, services, products or equipment, I agree to the following:I will not engage in unsportsmanlike conduct or encourage others to do so.
I will not engage in any behavior that would endanger the health, safety, or wellbeing of others.
I will not engage in the use of obscene language or gestures.
I will not use Wicket Corp. records, name, logos, trademarks, or materials for personal gain.
I will treat others with respect.
I will exhibit fairness and honesty in my dealings with others.
I will follow all rules, policies, procedures, and requirements established by Wicket Corp..
I will accept responsibility for my own actions.
I will exemplify the highest standard in ethical behavior and fair play.
I will properly supervise my children and any other minors who I bring to the premises or who participate in any Activities with me or under my supervision.
I will engage in conduct that is free from fear, discrimination, abuse, and harassment.
I will not give private lessons to anyone at Wicket Corp. for a fee without the expressed written consent from Wicket Corp.'s management.
I will not attempt to entice anyone at Wicket Corp. to pay me a fee for private lessons on other courts.
I understand and agree that my violation of this Code of Conduct, or other violations of this agreement or any of our rules, or any other harmful or otherwise unacceptable behavior may, in our at our sole and absolute discretion, result in the immediate removal from the premises, my participation in any Activities or use of facilities, products, services, or equipment, without refund of any fees, registration, or other amounts paid.

I agree that this waiver and use permission shall remain in full force from the date of my signature until I revoke said waiver and use permission by providing written notice to Wicket Corp..
I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without indictment or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.
Wicket Agreement*

Payment*

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USDUFCA Soccer Program - Winter 2026
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