Individual Registration Form - IF REGISTERING FROM A MOBILE DEVICE DO NOT USE ANY AUTOFILL OPTIONS. ALL OPEN FIELDS MUST BE ENTERED MANUALLY. IF YOU EXPERIENCE AN ERROR, PLEASE CONTACT SPLEX AND DO NOT RESUBMIT THE FORM.


Fill out this form completely, then press the "Submit Registration" button below.

Select Session
Player Information
Gender: Male  Female
Are you a Goalkeeper? Yes  No
Parent Information
Parent Interested in Coaching/Assisting?
Coaching
Assisting
No, Thank You
Special Requests
Payment Information
Fee: $
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Credit Card Information
Credit Card information must be entered in order to register. Your card will only be charged if you selected to charge the credit card above. If full payment has not been received by the identified Full Payment Due Date Date Goes Here published on the SportsPleX website, the credit card will be charged for the payment due as well as a late fee of $10.00.
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Expiration Date:
Card Holder Name:
Card Holder Address: (Street/House # only)
Card Holder Zip:
CSV Code (on back of card):
Release of Liability and Assumption of Risk

This release is executed on the acceptance of the electronic signature of the person(s), parent, or legal guardian whose name appears below in the City of Fairborn, County of Greene, State of Ohio, referred to as releasor.

In consideration of being permitted to participate in the inherently of dangerous sports activity of soccer, conducted in and by the facility known as Turfside Sports LLC, dba SportsPleX, releasor, for himself or herself and his or her personal representatives, heirs, assigns and next of kin, releases, waives, discharges and covenants not to sue Turfside Sports LLC dba SportsPleX, its owners, officers and members, employees, independent contractors, including but not limited to soccer officials, all referred to as releasees, from all liability to the releasor, representatives, assigns, heirs and next of kin for all loss or damage, and any claim or damage, on account of injury to the person or property or resulting in death of the releasor, whether caused by the negligence of releasees or otherwise while the releasor is for any purpose participating in or engaging in the activity of soccer. Releasor agrees to indemnify the releasees and each of them from any loss, liability, damage or cost releasees may incur due to the presence of releasor in or about the facility located at 5447 Intrastate Dr., Fairborn, Ohio 45324, otherwise known as SportsPleX, whether caused by the negligence of the releasees or otherwise.

Releasor assumes full responsibility for the risk of bodily injury, death or property damage due to negligence of releasees or otherwise while in or about, and/or while competing, officiating in, or coaching at SportsPleX, 5447 Intrastate Dr., Fairborn, Ohio 45324 whether caused by the negligence of the releasees or otherwise working or for any purpose participating in soccer.

Releasor agrees that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Ohio and that if any portion of the agreement is held invalid, it is agreed that the balance will notwithstanding, continue in full legal force and effect.

Releasor, being of lawful age for himself or as a parent and legal custodian of the minor, in consideration of being permitted to participate in soccer, does for himself or herself, his or her heirs, executors, administrators, and assigns, release and forever discharge Turfside Sports LLC dba SportsPleX, from all liability to the releasor, representatives, assigns, heirs and next of kin and their heirs, administrators and/or, and executors of and from any and every claim, demand, action or right of action, of whatsoever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death and/or property damage resulting or to result from any accident which may occur as a result of participation in soccer or any activities in connection with soccer, whether by negligence or not.

Releasor further states that he or she has as carefully read the above release and knows the contents of the release and signs this release as his or her own free act. Releasor further certifies that he is the authorized parent or legal guardian permitted to give consent for the participation of any minor child for whom he or she executes this agreement on behalf of the minor child.

Releasor further releases all officials and professional personnel from any claim whatsoever on account of first aid, treatment or service rendered him or her during participation in soccer.

This release contains the entire agreement between the parties to this agreement and the terms of this release are contractual and not a mere recital.

11/18/2018

I have read and agree to the Release of Liability and Assumption of Risk. Click Here To Print Release.
Your Name(Registrant over the age of 18 or Parent/Legal Guardian):
As Parent or Legal Guardian of Registrant I have read and understand the Ohio Concussion Law. Click Here To View/Print the Ohio Concussion Law.


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