EDGEWATER HIGH SCHOOL AMBASSADOR CLUB

FIELD OF DREAMS Co-Ed BUBBLE SOCCER REGISTRATION FORM

(Please Print Clearly)

Teams Name: __________________________________________________________

Your Name: ____________________________________________________________
Home Address: _______________________________________________________
City: __________________________ State __________Zip Code: ________________
Phone: ________________________________________________________________
Email Address: __________________________________________________________
Team Member Names: ___________________________________________________________

Be sure to include Entry Fee with your registration ($10/person). Fee non-refundable. Due at time of
registration. Registration deadline is March 31st at 2:00pm.

Space is limited. First come, first served. Only 16 teams will be allowed to participate. Five person
teams are required. No more, no less.
Cash or check accepted. Make checks payable to: Make-A-Wish Foundation of Central and Northern
Florida.

Minimum age requirement is 14 yrs of age. No exceptions. Please review information posted on the
Google Classroom page with code: pf6biv

I as a participant agree to abide by all Edgewater High School Ambassador Club and VOLUSIA Sports
LLC rules and regulations regarding this program. Edgewater High School and its affiliates (including
but not limited to E.H.S. Ambassador Club and Make-A-Wish Foundation) cannot be held liable for
injury.

Parental Approval and Medical Release

RECOGNIZING THE POSSIBILITY OF PHYSICAL INJURY ASSOCIATED WITH SOCCER PARTICIPATION
AND IN CONSIDERATION FOR EDGEWATER HIGH SCHOOL, EHS AMBASSADOR CLUB, MAKE-A-WISH
FOUNDATION OR ANY OF ITS AFFIIATES, I HEREBY RELEASE, DISCHARGE, AND/OR OTHERWISE
INDEMNIFY THE SOCCER PARTIES AND THEIR SPONSORS, EMPLOYEES AND ASSOCIATED
PERSONNEL, INCLUDING THE OWNERS OF FIELDS AND FACILITIES UTILIZED FOR THE PROGRAMS
AGAINST ANY CLAIM BY OR ON BEHALF OF THE REGISTRANT AS A RESULT OF THE REGISTRANTS
PARTICIPATION IN THE PROGAMS AND/OR BEING TRANSPORTED TO OR FROM THE SAME, WHICH
TRANSPORTATION I HEREBY AUTHORIZE. BY MY SIGNATURE BELOW, I CONFIRM THAT MY
SON/DAUGHTER IS PHYSICALLY CAPABLE OF PARTICIPATING IN THE PROGRAMS. I HAVE NOTED
ABOVE, ANY SPECIFIC ISSUE, CONDITION, OR AILMENT THAT MY CHILD HAS OR THAT MAY IMPACT
MY CHILDS PARTICIPATION IN THE PROGRAMS. I HEREBY GIVE CONSENT TO HAVE AN ATHLETIC
TRAINER AND /OR DOCTOR OF MEDICINE OR DENTISTRY PROVIDE MY SON/DAUGHTER WITH
MEDICAL ASSISTANCE AND/OR TREATMENT AND AGREE TO BE RESPONSIBLE FINANCIALLY FOR THE
REASONABLE COST OF SUCH ASSISTANCE AND/OR TREATMENT.

1
I FURTHER GRANT THE SOCCER PARTIES THE RIGHT TO USE THE PLAYERS NAME, PICTURES AND
OR LIKENESS IN PRINTED, BROADCAST AND OTHER MATERIAL CONCERNING THE PROGRAMS,
PROVIDED SUCH USE IS RELEATED TO THE PLAYERS STATUS AS A PARTCIPANT IN THE PROGRAMS.
YES NO

Participant Signature _______________________________ Date ____________________

Parent Signature __________________________ Date ____________________

This form is to be filled out completely and returned with full payment to:
Edgewater High School Attn: Caitlin Christmas
3100 Edgewater Dr.
Orlando, FL 32804

For additional information, please contact: caitlin.christmas@ocps.net

Office use only Entry Fee_________ Forfeit Fee_________ Date_________