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Program Guide Registration Last Name_______________________________________________ First Name________________________________________________ Street Address_____________________________________ City_______________________ State________ Zip Code____________ Home Phone Number__________________________________ Emergency Phone Number____________________________________ Email Address___________________________________________________________________ DOB____________ Gender________ ParentGuardian Last Name_______________________________________ First Name_______________________________________ I understand SportsOhio will send information to me by email but will not sell my email address to other groups or organizations. Programs PAGE PROGRAM NAME TIME FEE Participant Information Payment Total Fees_____________ Payment Method q Cash q Check q VISA q Mastercard q Discover Check ______________ Please make check payable to Field Sports Soccer First or The Golf Center at SportsOhio. Credit Card _________________________________________________ Expiration Date______________ V-Code_______________ Credit Card Holders Statement Address including zip_________________________________________________________________ T-Shirt Sizes For select programs only. YOUTH q S q M q L ADULT q S q M q L q XL q XXL Please complete entire registration form. Incomplete forms may cause delays in registration. There are no refunds for programs. Please check all facilities that apply q Soccer First q Field Sports q Golf Center Youth Waiver Release of Liability and Acknowledgment of Receipt of Ohio Department of Health Concussion Information This is to certify that I as parentguardian with legal responsibility for my minor child or ward acknowledge that my child or ward will be engaged in activities that involve risk of injury at Field Sports Inc. Soccer First Inc. The Golf Center at SportsOhio Inc. andor SportsOhio Inc. and that I do recognize and assume that risk whether foreseeable or not reasonably foreseeable on behalf of my child or ward and consent on behalf of my child or ward to hisher participation in activities and instruction at Field Sports Inc. Soccer First Inc. The Golf Center at SportsOhio Inc. andor SportsOhio Inc. For myself and on behalf of my child or ward and hisher legal representatives I hereby release and agree to indemnify Field Sports Inc. Soccer First Inc. The Golf Center at SportsOhio Inc. SportsOhio Inc. Steele Land Company their affiliates administrators directors agents coaches and its employees other participants and sponsor agencies from any and all claims and damages instituting or arising out of my minor childs or wards involvement or participation in the programs at Field Sports Inc. Soccer First Inc. The Golf Center at SportsOhio Inc. andor SportsOhio Inc. whether or not arising as a result of the negligence of the operators of such facilities. This is to further certify that I as parentguardian with legal responsibility for my minor child or ward acknowledge receipt of the Ohio Department of Health Concussion Information see page 3. ParentGuardian Signature _________________________________________________________Date _______________ Media Release I hereby allow SportsOhio Inc. and its affiliates Soccer First Inc. Field Sports Inc. The Golf Center at SportsOhio Inc. PowerPlay to record and publish photos and videos including audio of myself or minor child for the purpose of promoting SportsOhio and for documenting andor reporting events and activities. I understand photographs video andor audio tape recordings may be taken of myself andor family members at practice during competition recreational play as well as other SportsOhio Inc. related events. I understand that this media will be produced and used for promotional purposes and I authorize SportsOhio to use myour photograph video andor audio recording on its website and social media platforms such as Facebook Twitter YouTube etc. as well as other official printed publications without further consideration. I also understand that once my andor my family members images have been captured and are posted on the SportsOhio website or social media platforms the images can be downloaded by any computer user on or off the premises of the sports campus. ParentGuardian Signature _________________________________________________________Date _______________ All prices are subject to change.