Registration Coaching and Team Formation Info Registration-2017 Player InformationPlease register your child for the grade and school that they will attend for the Fall 2017 school year.Name* First Last Gender*MaleFemaleBirth Date* MM DD YYYY Home Phone*Street Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Grade in Fall 2017*-CHOOSE-3rd Grade4th Grade5th Grade6th GradeSchool Attending in Fall 2017Communication InformationPrimary Email* Email #2 Email #3 Cell Phone Number*(for text messages only) 10-digit number, Numbers only, no additional characters)Family InformationName* First Last OccupationDaytime PhoneCell PhoneRelationship*FatherMotherGuardianName First Last OccupationDaytime PhoneCell PhoneRelationship*FatherMotherGuardianEmergency InformationEmergency Contact*Phone*Email Special RequestsIf there are any special requests or medical information that the league should be aware of, please provide information below.Special RequestsDonationsMemorial 7, Inc. is a non-profit organization-501(c)(3) and all donations are tax deductible (excluding registration fees). Donations contribute to excess costs of the program beyond acceptable registration fees. Additionally, donations are used to help pay for scholarship athletes who are in need financially. The amount of your donation will be added to your total amount due and at the end of online registration. Thank you for your donation.Donation$5,000.00$3,000.00$1,000.00$750.00$500.00$250.00$100.00$50.00$25.00I do not wish to contribute at this time.Donate Other Amount Important Policy InformationImportant - Release of Liability and Additional Policy Information* I/we certify by checking each box that I/we are accepting these terms and conditions. And, the applicant named has my/our permission to participate in the Memorial 7, Inc. sports program in which we have signed up. I/we assume all the risks and hazards associated with such participation, including transportation to and from any associated activities. I/we hereby waive, release, absolve, and indemnify Memorial 7's officers, directors, commissioners, managers, coaches, supervisors, athletic trainers, medical trainers, participants, persons transporting my/our child to and from any Memorial 7 activities. I/we assume all the risks and hazards with respect to the use of the fields, from and against any liability for, or claim arising out of any accident or injury to said applicant occurring during the course of his/her participation in such activities or his/her transportation to or from such activities including but not limited to the sole or concurrent negligence of the Memorial 7, Inc., its officers, directors, commissioners, managers, coaches, supervisors, athletic trainers, medical trainers, umpires, referees, participants, persons transporting my/our child to and from Memorial 7 activities; and, the entities that Memorial 7 contracts with respect to the use of the fields. Memorial 7 will be responsible for all registrations for their programs that occur on The Village School's campus and will be required to have all participants sign and agree to a waiver of liability which would waive and release and hold Nord Anglia Education, and The Village School and/or its parent, subsidiary, related, and affiliated companies harmless from and against all claims, liabilities, judgments, costs, or other expenses of any kind arising out of use of The Village School's facilities and/or while on The Village School's property even though the liability may arise out of negligence or carelessness on the part of the parties named in the waiver. Memorial 7 further agrees to indemnify and hold harmless The Village School and Nord Anglia Education and/or its parent, subsidiary, related, and affiliated companies from and against all claims, liabilities, judgments, costs, or other expenses of any kind arising out of use of The Village School's facilities and/or while on The Village School's property even though the liability may arise out of negligence or carelessness on the part of the parties named. I/we hereby also waive, release, absolve, and indemnify any trainers, instructors, coaches, and organizations engaged by Memorial 7 (regardless of whether compensated by Memorial 7, Inc.) to assist with or operate any sports program, from and against any liability for, or claim arising out of any accident or injury to said applicant occurring during the course of his/her participation in such activities. I/we certify that it is understood that my payment is an enrollment fee only and the registrant will be assigned to a team determined by Memorial 7, Inc. at its sole discretion. I/we authorize the coaches of my child's team to act for me according to their best judgment in any emergency requiring medical attention. I have read, understand, and accept these terms and conditions. I/We consent to have my child be included in photography and videography at Memorial 7. (I understand that I must expressly inform the staff in writing if I choose to remove consent for my child's or children's inclusion in videography and photography). I/we (Player & Parents/Guardians) further agree to abide by all Memorial 7, Inc. rules and to conduct ourselves in a sportsmanlike manner during all related activities. We further agree to abide by all directions and decisions of the referees, coaches, and officials representing Memorial 7, Inc. We realize that violations of the above are consequential and could result in suspensions for future activities. Please check all boxes signaling your agreement to the policy. Volunteer OpportunityVolunteer Choices*I would like to be a coach or assistant coach; Memorial 7 will send you a coaching application.I would like to be a league assistant commissioner, school organizer or operations manager. Memorial 7 will send you an application.I would like to volunteer to assist with the league “fun-day”, pictures or fundraising. Memorial 7 will contact you.I do not wish to be a volunteer.Submit Registration InformationPlease review all information for accuracy and completeness, then click on the SUBMIT button to continue the registration process. League Registation Fee: $295 Refunds: There are no refunds after the close of registration, August 26, 2017. If requested before the close of registration, you will receive a refund, less $50 administration fee. Scholarships: Scholarships are available for families in financial need. Please email firstname.lastname@example.org for more information. **Note: You will be redirected to PayPal after you submit your registration to finalize payment for the league fee. The website is not charging you twice. Thank you and sorry for the inconvenience.**League Registration Fee* Price: $295.00 Total $0.00 Credit Card* DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle AJAX powered Gravity Forms.