Skip to content
Home
Shop
Teamwear
Uniforms
Coaching & Camps
Pathway 1894
About
Contact Us
Home
Shop
Teamwear
Uniforms
Coaching & Camps
Pathway 1894
About
Contact Us
$
0.00
0
Cart
Pekin Pride
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Youth Participation Waiver & Release of Liability
Are you a Pekin Pride player?
*
Yes
No
player? / purposes
1. PARTICIPANT INFORMATION
Child Name
*
First
Last
Date of Birth
Age
Select Group
Group 1 (GK Clinic)
Group 2 (Finishing Clinic)
Group 1 (GK Clinic)
Price:
$75
Age:
8-13 Years
Time:
5:00 PM to 6:00 PM
Group 2 (Finishing Clinic)
Price:
$75
Age:
8-13 Years
Time:
6:00 PM to 7:00 PM
Parent/Guardian Name:
*
First
Last
Phone
Email
*
Emergency Contact & Phone
2. ASSUMPTION OF RISK
Participation in soccer involves inherent risks including but not limited to falls, collisions, weather exposure, sprains, fractures, concussions, and other injuries. I voluntarily assume all risks associated with my child’s participation.
3. RELEASE OF LIABILITY
I hereby release and hold harmless Pathway 1894, its coaches, staff, volunteers, and facility partners from any and all claims arising from injury, illness, or loss related to participation.
4. MEDICAL AUTHORIZATION
I certify my child is physically fit to participate. In case of emergency, I authorize staff to seek medical treatment. I understand I am financially responsible for any medical expenses incurred.
Allergies / Medical Conditions
5. CONCUSSION POLICY
Pathway 1894 follows concussion safety protocols. Any participant showing signs of concussion (headache, dizziness, confusion, nausea, balance issues, sensitivity to light/noise, etc.) will be immediately removed from play and may not return without written medical clearance from a licensed healthcare provider.
6. HEAT & WEATHER POLICY
Outdoor sessions may be modified, rescheduled, delayed, or canceled due to extreme heat, lightning, or unsafe field conditions. Hydration breaks are mandatory during high temperatures. In the event of lightning within 10 miles, activities will be suspended immediately. Player safety is the top priority.
7. PAYMENT TERMS & REFUND POLICY
All registration fees must be paid in full prior to participation. Payments are non-refundable unless the program is canceled by Pathway 1894. Missed sessions due to illness, scheduling conflicts, or personal reasons are not eligible for refunds. Transfers to future sessions may be considered at the discretion of Pathway 1894.
8. PHOTO & MEDIA RELEASE
I grant permission for photos and/or video recordings taken during programs to be used for promotional purposes including social media, website, and marketing materials.
I grant permission for photos and/or video recordings taken during programs to be used for promotional purposes including social media, website, and marketing materials.
Yes
No
9. AGREEMENT & SIGNATURE
By signing below, I acknowledge that I have read, understand, and agree to the terms outlined in this waiver.
Parent/Guardian Signature
Clear Signature
Printed Name
Date
Submit
Search
Search