Anson Dorrance ClinicRegistration Form & Questions for Q&A Player Name * First Name Last Name Player Date of Birth * MM DD YYYY Player's Club & Team * Questions for Anson Please list 3 questions you would like to ask Anson and we will select a few questions from all of our participants for Anson to answer during the Q&A part of the clinic. Parent Name * First Name Last Name Parent Cell Phone * Country (###) ### #### Parent Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name * First Name Last Name Emergency Contact Cell Phone * Country (###) ### #### Emergency Contact Email * Waiver & Release of Liability * GENERAL RELEASE OF LIABILITY/WAIVER I, the Participant, or parent/guardian of the minor Participant(s), for myself and the minor Participant(s), acknowledge that soccer (and soccer-related activities) is an inherently dangerous sport in which the Participant participates at his/her own risk. I, for myself and the minor Participant(s) and and our respective heirs, administrators and successors, intending to be legally bound, hereby release and indemnify (1) US Soccer Federation, US Youth Soccer Association, US Club Soccer, and affiliated organizations and sponsors, (2) Dynamic Soccer (and Soccerbook Consulting LLC), and its officers, directors, coaches, managers, volunteers, agents, representatives and assigns, (3) the Palo Alto Unified School District, and its subdivisions, (4) the City of Palo Alto and all other organizations providing facilities, including their agents, officers, directors, contractors, employees, representatives and assigns (collectively “Released Parties”), from and against all claims, liabilities, damages or causes of action arising out of or in connection with the Participant's participation in any and all Dynamic Soccer (and Soccerbook Consulting LLC) services. I affirm that the Participant is in good physical condition. I understand that Dynamic Soccer (and Soccerbook Consulting LLC) does not carry medical insurance for Participants participating in clinics/camps, tryouts, practices, trainings, games, showcase events, friendly scrimmages and other Dynamic Soccer (and Soccerbook Consulting LLC) sponsored activities, and that I am responsible for the Participant's (or my own) insurance coverage and/or until the Participant is officially registered with the US Soccer Federation, US Youth Soccer Association or US Club Soccer. ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate in Dynamic Soccer (and Soccerbook Consulting LLC) programming, activities and events (collectively “Activities”), the undersigned acknowledges, appreciates, and agrees that: I, for myself or parent/guardian of the minor Participant(s), for myself and the minor Participant(s) on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Releasees their officers, directors, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the Activities, WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE ACTIVE OR PASSIVE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I, for myself or parent/guardian of the minor Participant(s), for myself and the minor Participant(s) and on behalf of my heirs, assigns, personal representatives and next of kin, hereby agree to defend and indemnify RELEASEES for all such claims, causes of actions, allegations or matters arising out of, relating to, based upon or in any way connected to my participation and/or the minor Participant(s) in such Activities. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO THE TERMS, AND AGREE TO IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Terms & Conditions * Please read our general terms and conditions here: https://www.dynamicsoccer.com/terms GENERAL RESTRICTIONS ON USE: The rights granted to you by these Terms will remain in force only for so long as these Terms remain in effect. You may not rent, transfer, assign, commercially exploit, resell or sublicense access to the Summer Package to any third-party. You may use the Dynamic Soccer Site and the Services only for your personal, non-commercial purposes. Except as expressly stated herein, no part of the Site or Services may be copied, reproduced, distributed, republished, downloaded, displayed, posted or transmitted in any form or by any means. Any future release, update, or other addition to functionality of the Site or Services shall be subject to these Terms. You promise that any information about yourself that you voluntarily provide to us will be true, accurate, complete and current. I, the Participant, or parent/guardian of the minor Participant(s), for myself and the minor Participant(s) or user(s) of Dynamic Soccer services, have read and agree to the terms and conditions located at the link above. Cancellation & Refund Policy * There is a no refund policy for the Anson Dorrance Clinic. Dynamic Soccer reserves the right to cancel or reschedule the Clinic, in which case, a refund or credit for the session(s) will be applied. I, the Participant, or parent/guardian of the minor Participant(s), for myself and the minor Participant(s) or user(s) of Dynamic Soccer services, have read and agree to the cancellation & refund policy above. Thank you for completing & submitting an Application for the Anson Dorrance Clinics. We will reply to your application within 72 hours by email.