2022 Summer Camp Volunteer Request

Please complete this form if you are interested in volunteering at a summer camp. High School Juniors and Seniors can help fulfill their volunteer obligation by helping as a coach for CSC's summer camps. At the end of the week, Camp Director Tom Karanas will sign/complete the necessary forms to ensure hours are submitted to the High School.

CAMP INFORMATION

DATES:
WEEK 1: JUNE 27 - JULY 1 (5-8 YEAR OLD BOYS AND GIRLS)
WEEK 2: JULY 11 - 15 (9-12 YEAR OLD BOYS AND GIRLS)

TIME: 9:00AM-12:00PM (Volunteer work hours are 8:45am-12:00pm)

LOCATION: CLARENCE SOCCER CENTER (10000 CLARENCE CENTER ROAD, CLARENCE, NY 14031)

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* 1. Please enter PARENT/GUARDIAN information below (individual completing this form).

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number (Cell)

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* 2. Please enter VOLUNTEER (CHILD) contact information below.

First Name

Last Name

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* 3. Please select the WEEK(S) the child will be volunteering.

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* 4. AGE of VOLUNTEER (CHILD) mentioned above.

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* 5. GENERAL RELEASE: Recognizing the possibility of injury associated with soccer and in consideration for the USSF/USYSA and its affiliates, including the Clarence Soccer Club, accepting the registrant for its soccer programs and activities, I hereby release, discharge, and/or otherwise indemnify the USSF/USYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the Clarence Soccer Club, and the owners of the fields and facilities utilized for the camp against any claim by or on behalf of the registrant as a result of the registrant’s participation in the scrimmage and/or being transported to or from same, which transportation I hereby authorize. Further my son/daughter has received a physical examination by a physician and has been found physically capable of participating in the program/tournament

I , the PARENT/GUARDIAN completing this form, agree to the above statement and have completed all questions on this form truthfully.

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* 6. PHOTO RELEASE: I hereby give my consent for the Clarence Soccer Club to use any photos/videos of myself and/or minor child, in future Clarence Soccer Club brochures, flyers, websites, photos and videos of its programs and their participants, which may be used for promotional and instructional purposes. Furthermore, I understand that all such photos/videos remain the property of the Clarence Soccer Club.

I , the PARENT/GUARDIAN completing this form, agree to the above statement and have completed all questions on this form truthfully.

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* 7. ASSUMPTION OF RISK: In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:

I am aware there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or resulting from an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any mutation or variation thereof.

I acknowledge my responsibility not to play or practice if I am exhibiting symptoms of COVID-19. If, however, I observe any symptoms during my participation or presence at a game or practice, I will remove myself from participation, and bring such to the attention of my coach or team official immediately.

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE (NAME OF ORGANIZATION), its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

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 SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do acknowledge my responsibility to restrict my child from play or practice if they exhibit any symptoms of COVID-19, and consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

I , the PARENT/GUARDIAN completing this form, agree to the above statement and have completed all questions on this form truthfully.