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Registration Form

Select Camp Location
Select Payment Method

Please make check payable to: Kick Start Soccer Academy
Mail Payment to: 38 Beechwood Ave Manhasset, NY 11030
Venmo ID: @KickStartSoccer

Kick Start Soccer Academy LLC retains the rights to any photographs or video tapes of the campers taken at camp to be used for publicity or advertising. I understand that as of June 14th, 2024 cancellations are non-refundable. 

Thanks for submitting! You will receive email confirmation. Please also fill out our Parental Consent and Release Waiver below.

Parental Consent and Release Waiver

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT

IN CONSIDERATION of being permitted to enroll your child 

Into the For Girls By Girls by Kick Start Soccer Academy, including but not limited to its Soccer, lacrosse and flag football Clinics, tournaments and/or Soccer Summer Camps (“activity” or “Activity”). I, hereby acknowledge, agree, covenant and represent the following:

1. I am the parent or guardian of the participating child and have full legal authority to enroll said participating child in the Camp Beast Mode camp, by Kick Start Soccer Academy. I also have full legal authority to enter into this agreement on behalf of said participating child.

2. I acknowledge and agree that Soccer, Lacrosse and Flag Football Sessions and/or Summer Camp Activities are inherently dangerous activities that may involve risk of serious bodily injury, including permanent disability, paralysis and even death ("Risks"), and that such Risks may be caused by the actions of my child or of other children enrolled in the Camp Beast Mode by Kick Start Soccer Academy. I fully accept and assume all such Risks, and I fully accept and assume all responsibility for injury and any resulting damage, including any losses, costs and damages that may be incurred as a result of any such injury.

3. I understand the nature of instructional sports and/or summer camp activities and I am familiar with the participating child's experience and capabilities. I believe the minor to be in good health and otherwise qualified to participate in such activities.

4. I hereby Release, Discharge, Covenant and Agree not to sue Kick Start Soccer Academy, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, owners and lessors of premises on which the Activities take place, (“RELEASEES”) from all liability, claims, demands, losses, or damages caused or alleged to be caused in whole or in part by the negligence of the “Releasees'' or other participants in the Kick Start Soccer Academy, including negligent administration of emergency care. I further agree that if I, or anyone on my behalf, makes claim against any of the Releases, I will indemnify, save, and hold harmless each of the Releasees from any litigation expenses, attorney fees, loss, liability, damage, or costs which may be incurred as the result of such claim, and that I will reimburse any Releases the cost of attorneys fees and/or litigation expenses incurred in defending such a suit.

5. I intend that this Agreement shall be binding upon my heirs, personal representatives, assigns and next of kin.

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR COERCION, AND WITHOUT ASSURANCE OF ANY NATURE, AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE FULLEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. 

Thanks for submitting! You will receive email confirmation.

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