Registration packet 2015.16

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MICHIGAN RUSH JACKSON
Player Registration Pack 2015/16
Welcome to Michigan Rush Jackson. We look forward to working with your player and hope this
year will be a fun, challenging and rewarding year for each player.
Registration Process Includes:
1. Online Registration: Complete Prior to June 18, 2015
Link:
! Only exception is do not register if applying for OPS Scholarship until you receive scholarship
confirmation, by June 27th.
2. Turn in Documents:
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Family contact information sheet
Player contract: only if not signed at tryouts
" CMSA Forms U8-U10,WSSL U11-U12, MSPSP U13-U18
Notarized MSYSA medical release (U8-U10 Players Also need CMSA Medical Release)
Rush Accident Waiver
Website waiver
Concussion Waiver, 2 copies
OPS Scholarship Fund, if applying for a Scholarship give directly to Josh McKenna
3. Club Registration Night:
Thursday June 18th 5:00-8pm at Grace Church, 2692 N. Dettman Road, Jackson
Located at the Gym in back entrance and parking lot
• 5.00-5:45pm U8-U11 Teams
• 5:45-6:30pm U12-U14 Teams
! 6:30-7pm U15-U18 Girls Teams
! 7-7:30pm U15-U18 Boys Teams
What to do at Registration Day?
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Find the coach/manager from your team. He/She will be at a table.
Turn in required paperwork to your coach/manager.
Try uniforms on, write sizes down for all items, if needed. You will have to order and pay for
everything online at a later date and pick up Eurosport’s online ordering form to help with the
online ordering. You will receive a follow up email with further ordering instructions.
After Registration Day
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Order uniforms (Follow Eurosport online instructions)
Your team coach will contact you regarding Fall team training times
See everyone at team camp!
" U9-U14 July 28th-31st 9am-12pm/ U15-U18 Girls July 28th-31st 6:30-8:30pm
If you have any questions please contact your team coach/manager or Josh McKenna,
mckenna.joshua85@gmail.com, 352.422.4053
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Overview of Paperwork to be Filled Out:
$% CMSA Players Teams:
! Pages 3, 4, 5, 6, 9
&% WSSL Players & Teams:
! Pages 3, 4, 5, 7, 9
'% MSPSL Players & Teams:
! Pages 3, 4, 5, 8, 9
**Page 9, Medial Release Form, must be notarized.
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MICHIGAN RUSH Jackson
Family Contact Information
Player’s Name
_____________________________________________________________
Mother’s Name
________________________________________________________________________
Father’s Name
________________________________________________________________________
Player’s Date of Birth (MM/DD/YYYY)
________________________________________________________________________
Mailing Address (Street, City, Zip)
________________________________________________________________________
________________________________________________________________________
Player’s Email
________________________________________________________________________
Mother’s Email
________________________________________________________________________
Father’s Email
________________________________________________________________________
Player’s Cell (123-456-7890)
________________________________________________________________________
Mother’s Cell
________________________________________________________________________
Father’s Cell
________________________________________________________________________
Emergency Contact (Name and Number)
________________________________________________________________________
Please write legibly
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ACCIDENT WAIVER AND RELEASE OF LIABILITY
MICHIGAN RUSH 2015-2016
I acknowledge that participation in the Michigan Rush carries with it the potential for injury.
I certify that I am physically fit to participate and have not been advised otherwise by a
qualified medical personal. I acknowledge that this Accident Waiver and Release Liability
form will be used by the Michigan Rush, and that it will govern my actions and
responsibilities.
Player and parent acknowledge the following:
I acknowledge that there are certain anticipatable dangers associated with participating in Club events,
Optimal Performance Specialist (OPS), including participation in indoor and outdoor soccer practices,
competitions, and travel to and from those practices and competitions. I assume all risk and hazard of
injury to player in the course of a club event.
I acknowledge that the club and OPS does not provide or maintain insurance of any kind whatsoever,
including without limitation, insurance which would cover the cost of medical, dental, or therapy arising
from participation in the Club events.
On behalf of themselves and their assignees, release and hold harmless the Club and OPS from any and
all liability and expense, including litigation costs and attorney fees arising out of any and all claims which
Parent and/or Player may have. Parent and player also waive as to the club, and to all of their directors,
officers, officials, employees, coaches, representatives and agents (“Club Affiliates”), any claim or
damages Parent and/or Player may have as a result of the Parent and Player participation in a Club Event
(including transportation to and from the event) and including any facilities provided directly or indirectly
by the club.
I shall hold harmless and indemnify the Club, and Club Affiliates from any and all claims, liabilities, and
expenses arising out of claims brought by third parties in connection with any acts or omissions of Player
and/or any parent, guardian, sibling or other relative of Player, who attends and participates in a Club or
OPS Event and any injury to Player him/herself.
I acknowledge that this document shall be operative as to any Club event which occurs now or in the
future and in which Player is participating, Regardless of teams, participants, facility or location, and that
no coach or official, other than the full Michigan Rush Board, may waive or alter the terms of this
document.
Player and parent have read the terms of this agreement and they understand and fully
agree to the same as binding upon them, their heirs and personal representatives:
Player Name: _________________________Team:________________________
“Parent” Acceptance
As a parent or guardian of the Player identified above, I have reviewed the Accident Waiver and Release
of Liability form and ACCEPT the terms and conditions contained herein.
Parent/Guardian Signature: _________________________Date:_________________
Parent/Guardian Signature: _________________________Date:__________________
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MICHIGAN RUSH PLAYER INFORMATION
Website Waiver /Authorization and Release 2015-16
I am the parent or legal guardian of ____________________________________ (“Player”),
and I consent and authorize the Michigan Rush Club, or any of its affiliates, Club teams, past
and present officers, representatives, coaches, managers, agents, or employees (collectively,
“Club”) to use and reproduce Player’s name, profile, background information, athletic
participation history, academic history, grade point average, test scores, statistics, honors, or
any other information provided by me (us) on the Player Profile Form (“Profile Information”),
and I further authorize Club to edit, modify, or rearrange Profile Information for posting to a
website, printing, reproducing, publishing, or disseminating in any other manner. I also consent
and authorize the Club to take photographs (“Photos”) of Player and to post the Photos on the
Club’s website, or print, reproduce, publish or otherwise disseminate such Photos in Club
marketing materials; provided, however, the Player’s name or other personal information will
not appear with the Photos unless it is part of the Profile information provided by me (us).
I hereby waive and release Club from any and all actions, causes of action, lawsuits,
claims, injuries, warranties, trespasses, torts, losses, agreements, promises, demands or other
liability or relief of any nature whatsoever, whether known or unknown, foreseen or unforeseen,
resulting from the Club’s use of Photos or Profile Information as authorized by this Authorization
and Release.
I promise to indemnify and hold harmless Club from any claim or action the Player,
Player’s parent or legal guardian, or anyone brings against Club as a result of any use
authorized by this Authorization and Release form. I acknowledge that I have voluntarily
provided the Profile Information for this use, and that this Authorization and Release is given
voluntarily.
Player Name______________________________________
Team__________________________
Parent/Guardian________________________________
Date___________________________
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WESTERN SUBURBAN SOCCER LEAGUE
PLAYER REGISTRATION FORM - Fall 20______ / Spring 20______
Name________________________________________________________________________________________
LAST FIRST MIDDLE
Address ___________________________________________________ Date of Birth________________________
MONTH DAY YEAR
City __________________________State ______ Zip_______________ Phone (_________)_________-________
I voluntarily desire to play soccer for the _____________________________________________________
AFFILIATING CLUB or ASSOCIATION TEAM NAME
competing in the Western Suburban Soccer League (WSSL). I understand that signing this form binds the above
named player to the above named affiliating club or association for the entire seasonal year (both Fall/Spring) unless
an application for the transfer to another league is approved by the WSSL using the WSSL Player Transfer Form.
Transfer between WSSL Clubs or Associations will NOT be approved.
Signature of Player ! _____________________________________________________ Date _______________
Signature of Parent/Guardian ! _____________________________________________Date _______________
I understand that signing this form binds the above named affiliating club or association to the above named player
for the entire seasonal year (both Fall/Spring) unless an application for the transfer to another league is approved by
the WSSL using the WSSL Player Transfer Form. Transfer between WSSL Clubs or Associations will NOT be
approved.
Signature of Coach/Team Official ! __________________________________________ Date _______________
Signature of Affiliating Club or
Association President or Registrar ! _________________________________________Date _______________
I, as the Affiliating Club or Association President or Registrar, confirm documentation is on file with the Affiliating Club
or Association that certifies the player’s age eligibility.
WESTERN SUBURBAN SOCCER LEAGUE
Athletic Waiver and Release of Liability
In consideration of being allowed to participate in any way in WSSL sanctioned soccer activities, the undersigned:
1. Acknowledges and fully understands that each participant will be engaging in activities that involve risk of serious
injury, including permanent disability and death, and severe social and economic losses which might result not only
from their own actions and/or inactions, but the negligence of others, the rules of play, or the condition of the
premises or of any equipment used, and acknowledges further, that there may be other risks not known or not
reasonably foreseeable at this time; 2. Assumes all the foregoing risks and accepts personal responsibility for the
damages following such injury, permanent disability or death;3. Releases, waives, discharges and covenants not to
seek any legal action against the WSSL, its member Associations, Affiliated
Clubs, or teams and their respective administrators, directors, agents, coaches, and other employees of the
organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of
premises used to conduct the event, all of which are hereinafter, referred to as “Releasees”; from demands, losses or
damages on account of injury, including death or damages to property, caused or alleged to be caused in whole or in
part by the negligence of the “Releasees” or otherwise; 4. Agrees, in further consideration for my child’s participation,
to hold harmless and indemnify the “Releasees” for any injury resulting from my child’s conduct in the program; 5.
Agrees to accept and abide by all the rules, regulations, code of conduct and policies stated by the WSSL.
Printed Name of Parent/Guardian_________________________________________________
Signature of Parent/Guardian !___________________________________________________
Date______________
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Optimal Performance Specialists Scholarship Fund
Michigan Rush Jackson Financial Assistance Request Form 2015-2016
Player’s Name: _____________________________
Age Group (ex: U12 Boys): ________
Years Played within Rush: ____________
Parent 1 Name: _____________________________
Parent 2 Name: __________________________
Address: ___________________________________
Address: _________________________________
Home Phone:
Work Phone:
Cell Phone:
Email:
EMPLOYMENT
Parent 1: Currently Employed: Yes No Occupation:
Home Phone:
Work Phone:
Cell Phone:
Email:
Name of Employer:
Phone:
Parent 2: Currently Employed: Yes No Occupation:
Name of Employer:
Phone:
INCOME
Annual Gross Income (combined if two parent income): __________
Household Members (list names and ages): ____________________________________________________
Briefly explain the reason(s) for your request; use back of form or attach a separate page.
Financial Assistance Matrix (used to determine level of assistance):
Part A:
Age Group and Annual Fee
Part B:
Requested Percentage of Assistance
U15-U18 HS/Nero: $687
U15-U18 Girls: $892
U15-18 Girls: $907
U13-14 Boys/Girls: $1,275
U11-12 Boys/Girls: $1, 262
U9-10 Boys/Girls: $970
U8 Boys/Girls: $480
10% assistance = .9
20% assistance = .8
25% assistance = .75
50% assistance = .5
75% assistance = .25
Calculate Total Club Fee Capable of Paying:
$_________ Club Fee from Part A
x ________ Requested Percentage of Assistance from Part B (ex: 75 % assistance = .25)
_____________ Requested Total Club Fee to be Paid by Family/Guardian
Ex: $1,275 (u14 boys) x .25 (75% assistance) = $324.25
Financial Aid is NOT guaranteed. An email will be sent to your family by June 27th, 2015 notifying you of the level of
support you will receive. All club fees will be collected after the club has responded with the level of financial aid your
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family will receive, do not make online parent until the club confirms scholarship amount rewarded. A payment plan
will be offered to your family outlining the amount of money due, along with when it is due. Failure to meet the
minimum monthly payments, and to attend sessions and/or games regularly may result in loss of assistance and/or
removal from the program.
I declare the above personal and financial information is accurate and I will submit my most recent federal income tax
form or form with proof of income. I understand that receiving financial assistance is a privilege and pledge to have
my child at all team activities with soccer as a priority over other athletic activities, and pledge for my family and/or I to
volunteer at club events (tryouts, Rose City Soccer Tournament, etc.) as assigned by the club directors. Failure to
honor commitments may result in loss of assistance and/or removal from the program. I also recognize the
scholarship may cover partial fees and I am responsible for paying the remaining balance, and I am responsible for
non-club expenses (personal travel, extra events/expenses outside club fees, uniforms, tournaments ref fees, etc.)
Financial assistance recipients must notify the club directors of their intentions for the 2014-15 soccer year (leaving
for a new club, remaining with the club, not playing soccer, etc) in writing by May 15, 2015. Failing to do so could
result in the forfeiture of any future financial assistance.
Parent(s) signature:
Date:
All information submitted and any financial assistance granted will be kept strictly confidential by the officers of the Rush
Jackson Soccer Club. Completed applications can be turned in at Club Registration evening on June 18th or emailed to
mckenna.joshua85@gmail.com. Please place your application and proof of income in a manila or mailing envelope with the players
name on that envelope. Applications will be reviewed and families will be contacted regarding their financial assistance by June 27,
2015.
APPLICATIONS are due by June 18, 2015. If forms are not turned in by June 18 you may not be considered for financial aid.
Please use the other side or attach a separate page if you would like to add additional information regarding your family’s situation.
If you have more than one child in the Rush Jackson Soccer Club and would like financial assistance for each child, please use one
form for each child. Questions: contact Josh McKenna, 352-422-4053, mckenna.joshua85@gmail.com
Volunteer Events for Families Receiving Financial Assistance
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All times/dates/responsibilities are subject to change
Families will be assigned responsibilities based on the level of financial assistance
received
Responsibilities may include involvement before, during and after events
Club/Team Fundraisers: (PARENT AND/OR PLAYER HELP)
• Some Rush Jackson teams may chose to participate in various fundraisers to off set
additional fees (tournament, team travel, rush festival, etc.)
• Volunteering to help coordinate these efforts would be helpful
Rose City Soccer Tournament: club tournament June 3-5, 2016 (PARENT AND/OR PLAYER
HELP)
Pre-tournament: organize binders, solicit sponsors/advertisers
June 3: help set-up event
June 4-5: on-site tournament help at Cooperstown, Marino’s or Ella Sharp Soccer Complexes
(set-up/clean-up, score reporting, field marshal, concession sales, etc.) 6-10 AM, 10 AM-2 PM,
2-6 PM, 6-10 PM
2015-16 Club Tryouts: field set-up/clean-up, player registration, etc. at Marino’s Park
(PARENT HELP)
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