Ackerman Spring 2026 Registration

UFCA Spring 2026 Registration

Ackerman Park, Glen Ellyn, 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.Format: (000) 000-0000.
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.Format: (000) 000-0000.
Medical/Hospital Insurance Company
Date Signed*

MonthDayYear
Date
Parents/Guardians' Signature*

Clear

Payment*

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UFCA Spring 2026 Registration