Kosmos FC East Registration

Player Registration/Waiver Form

Fill out the form carefully for registration
Player 1 Full Name *

First Name Middle Name Last Name
Player 2 Full Name

First Name Middle Name Last Name
Player 3 Full Name

First Name Middle Name Last Name
Player 1 Date of Birth *

Year Month Day
Player 2 Date of Birth

Year Month Day
Player 3 Date of Birth

Year Month Day
Player 1 Gender *
Player 2 Gender
Player 3 Gender
Player 1 Session Choice *
Player 2 Session Choice
Player 3 Session Choice
Players 1 Jerseys Size *
Players 2 Jerseys Size
Players 3 Jerseys Size
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Guardians Name *

First Name Last Name
Guardians E-mail *
example@example.com
Guardians Mobile Number *

Area Code Phone Number
2nd Guardians Name *

First Name Last Name
2nd Guardians Phone Number *

Area Code Phone Number
Guardians E-mail *
example@example.com
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Photograph & Video Release Form

I hereby grant permission to NY Kosmos FC Inc, the rights of my child’s image, likeness and sound of their voice as recorded on audio or video tape without payment or any other consideration. I understand that my child’s image may be edited, copied, exhibited, published or distributed and waive the 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 my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area. Photographic, audio or video recordings may be used for the following purposes: Social media (Twitter, Instagram, Facebook, ect) Youtube.com TSTSoccerNY.com & Kosmosfc.com Website. By agreeing to this release I understand this permission signifies that photographic or video recordings of my child may be electronically displayed via the Internet or in the public educational setting. I will be consulted about the use of the photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only. By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
I agree with everything stated in the "Photograph & Video Release Form" above and give Photo and Video consent to Kosmos Fc & TST *

I agree with everything stated in the "Photograph & Video Release Form" above and give Photo and Video consent to TST
Medical Release Form

IN CONSIDERATION of being permitted to participate in any soccer-related activities I, for myself for personal representatives, assigns, heirs, and next of kin:

1. ACKNOWLEDGE, agree, and represent that I understand the nature of the soccer program that my child is participating in and that my child 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 I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. I agree to allow my child to be treated, if necessary, by a Kosmos FC Coach/physician/trainer/staff.

2. FULLY UNDERSTAND THAT: (a) SOCCER RELATED-PROGRAMS INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inaction’s, the actions or inaction’s of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) 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 I incur as a result of my participation or that of the minor in the Activity.

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE TST TOUROS SOCCER TRAINING, TST FUTSAL, TST SPORTS OR, NY KOSMOS FC Inc ATHLETIC AND CULTURAL ORGANIZATION AND /OR KOSMOS YOUTH SUMMER CAMPS, its staff, officers, agents, representatives, employees and successors (each considered one of the "RELEASES" 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 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.

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 INDUCEMENT 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.
I agree with everything stated in the "Medical Release Form" above. *

I agree to terms & conditions above
Have you, your child or a member of your household been diagnosed with COVID in the last 14 days *

Yes No
Have you, your child or a member of your household have had any Symptoms of COVID in the last 14 days *

Yes No
Have you, your child or a member of your household been around someone who has tested positive for COVID in the last 14 days *

Yes No
I understand that if my child has any symptoms of COVID that I should not send them to training. *

Yes No
I understand that if my child has any symptoms of COVID while at the field then Kosmos FC East will notify me and send my child home with my child's listed guardians. *

Yes No
I understand that if my child does not follow COVID social distancing requirements set in place then they will be sent home and not invited back to training. *

Yes No
Signature - Agreeing to terms above (sign with finger on mobile devices, sign with mouse on desktop) *

Clear
Print name to confirm above signature *
Date Signed *

Month Day Year
Date

Training Fee

Kosmos FC East - Summer training $ 220.00

One week of training

Quantity

Kosmos FC East - Two weeks of training $ 415.00

Two weeks of training with a 10% discount included

Quantity

Enter coupon

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

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Player Registration/Waiver Form

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