PlayerName-_________________________Team-________Year-______Boy/GirlLocation(circleoneofthreeareas)–•North/Hville•NorthBronco

Mailto:MicheleLaubach7594UntzRdConcord,NC28027

•Huntersville

2020-2021CSAPlayerRegistrationRequirements

• DEADLINEfor2020-21paperwork–***July8,2020***• NOFAXEDorEMAILEDcopiespermitted.• Single-sidedformsonly• Commitmentpaymentandpaperworkmustbesubmittedbeforeplayerisrostered.

NewtoCSA(Classic,Youth

AcademyorFormerRec/JAplayer)

ReturningtoCSA RequiredDocumentsbyAllPlayers

Two(2)printedcopiesrequired,single-sided

Two(2)printedcopies

required,single-sided

NCYSAMedicalConsent/WaiverofLiabilityFormOriginalsignatureininkrequiredononeoftheforms

Yes Yes SignedNCYSACommunicableDiseaseReleaseofLiabilityYes Yes SignandsubmitCSAPlayer&FamilyParticipationContract

Yes YesSignandsubmitCSAFinancialAgreement

• IncludetheClubfeeamountandteamnameatthetopoftheAgreementform–seefeechart

Yes Yes CDCConcussionAwarenessform–NEWfor2020-21All-Yes No AcopyofaBirthCertificateorpassport

NewtoCSA

FormerRec/JAplayers

ReturningCSAplayers,birth

year2002,2003,2004,2005,

2006

BirthYearsof2002-2006NEWtoCSA,FormerRec/JAplayers

• Emailphotostophoto@charlottesocceracademy.com• Nohatsorsunglasses• Playersshouldersandup• Mustbeacolorphoto• Sendthepictureinjpg.Filesizelessthen100KB• EmailSubject-playersfullname/birth

year/location• Playerlocation–North/Matthews-MintHill/Charlotte/

Huntersville/UptownorPalisades***SOUTHCAROLINARESIDENTSONLY******ALLSCRESIDENTSMUSTCOMPLETE***

InterstatePermissionFormandpaymentneedtobecompletedontheSCYSAwebsite.Pleasefollowdirectionson:http://scysa-scoos.sportsaffinity.com/reg/index.asp

PlayercardwillnotbeissueduntilSCresidentisclearedbySCYSAWhencompletedcorrectly,confirmationpaperworkwillbeissuedtobeprinted.

ForeignBornORForeignBorn–USCitizen-ONLYTheSoccerFederationisrequiringthatallforeignbornplayersorforeignborn–USCitizenscompletepaperworkandbeclearedbytheFederationbeforeanyplayercanparticipateinacompetitiveprogramwithinNCYSA.Ifyourson/daughterwasNOTbornintheUnitedStatespleasedownloadandprinttherequiredpaperworkhttp://www.charlottesocceracademy.com/Default.aspx?tabid=925489.AnyquestionsregardingtheformspleasecontactTriciaKarhnakatregistrar@charlottesocceracademy.com

MAILFORMSTO:MicheleLaubach7594UntzRdConcord,NC28027

NORTH CAROLINA Medical Consent / Waiver of Liability and Release (To be given to your local association)

20 ____ - 20____ NCYSA NCYSA Policy #

Excess policy to any valid and collectible PO Box 18229 insurance. If there is no primary insurance on Greensboro, NC 27419 insurance on a player, this policy is 336.856.7529 primary after the deductible. Player First Name M Initial Last Name Full Association Name Jersey # (AS APPEARS ON BIRTH CERTIFICATE) [ ] Academy [ ] Challenge [ ] Classic [ ] Recreation [ ] Male [ ] Female Birth Date Level Sex Address of Player City State Zip Parent/Legal Guardian Full Name Home Phone Work Phone Cell Phone Additional Person to Contact in an Emergency Address Home Phone Cell Phone Date of Last Tetanus Shot Medications now being taken Player is Allergic to these Medications and Substances List any Unusual Health Information Parent Email For Soccer Information I (we), the undersigned, residing in the county of , state of _________, the parents/legal guardian of the above Registrant, a minor, who resides with us, do hereby declare our intent to allow that child to practice, train, play and participate in all soccer-related activities with the above mentioned soccer team affiliated with the North Carolina Youth Soccer Association and the United States Youth Soccer Association. I (we) agree that we and the Registrant will abide by the rules of the USYS, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYS and NCYSA accepting the Registrant for their soccer programs and activities (the “ Programs”), we hereby jointly and severally release, discharge and/or otherwise indemnify the USYS, NCYSA, their affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized by the Programs, against any claim by or on behalf of the Registrant as a result of the Registrant’s participation in the Programs and/or being transported to or from the same, which transportation we hereby authorize. I (we) further, jointly and severally, as parents and legal guardians of the Registrant, release, discharge, and agree to hold harmless and indemnify the above-named individuals or any of the designated coaches of the above Team from any and all liability, claims or demands arising from the Registrant participating in the Programs with the above Team specifically to include any and all claims for personal injuries sustained while present or participating in the Programs or traveling to or from events in the Programs or while on trips sponsored by or in conjunction with the Programs. In addition, I (we) do hereby authorize any one of the designated adults of the Team, if after a reasonable attempt has been made to reach a parent or guardian to obtain consent or if sound medical practice decrees that there is not time to make such an attempt, to consent to any x-ray examination, anesthetic, medical or surgical procedure, treatment, and/or hospital care, to be rendered to the Registrant under the general or special supervision of and/or on the advise of any physician, surgeon or dentist duly licensed to practice. The undersigned have read and fully understand and agree to the foregoing. Insurance Information: Name of Insurance Company: **Parent/Legal Guardian Signature ID Number: **No Electronic Signature Permitted

Confirmation Number: _____________________________________________ Date

Original (Team) Copy (Association)

NORTH CAROLINA Medical Consent / Waiver of Liability and Release (To be given to your local association)

20 ____ - 20____ NCYSA NCYSA Policy #

Excess policy to any valid and collectible PO Box 18229 insurance. If there is no primary insurance on Greensboro, NC 27419 insurance on a player, this policy is 336.856.7529 primary after the deductible.

Player First Name M Initial Last Name Full Association Name Jersey # (AS APPEARS ON BIRTH CERTIFICATE)

[ ] Academy [ ] Challenge [ ] Classic [ ] Recreation [ ] Male [ ] Female

Birth Date Level Sex

Address of Player City State Zip

Parent/Legal Guardian Full Name Home Phone Work Phone Cell Phone

Additional Person to Contact in an Emergency Address Home Phone Cell Phone

Date of Last Tetanus Shot Medications now being taken

Player is Allergic to these Medications and Substances

List any Unusual Health Information Parent Email For Soccer Information

I (we), the undersigned, residing in the county of , state of _________, the parents/legal guardian of the above Registrant, a minor, who resides with us, do hereby declare our intent to allow that child to practice, train, play and participate in all soccer-related activities with the above mentioned soccer team affiliated with the North Carolina Youth Soccer Association and the United States Youth Soccer Association.

I (we) agree that we and the Registrant will abide by the rules of the USYS, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYS and NCYSA accepting the Registrant for their soccer programs and activities (the “ Programs”), we hereby jointly and severally release, discharge and/or otherwise indemnify the USYS, NCYSA, their affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized by the Programs, against any claim by or on behalf of the Registrant as a result of the Registrant’s participation in the Programs and/or being transported to or from the same, which transportation we hereby authorize.

I (we) further, jointly and severally, as parents and legal guardians of the Registrant, release, discharge, and agree to hold harmless and indemnify the above-named individuals or any of the designated coaches of the above Team from any and all liability, claims or demands arising from the Registrant participating in the Programs with the above Team specifically to include any and all claims for personal injuries sustained while present or participating in the Programs or traveling to or from events in the Programs or while on trips sponsored by or in conjunction with the Programs.

In addition, I (we) do hereby authorize any one of the designated adults of the Team, if after a reasonable attempt has been made to reach a parent or guardian to obtain consent or if sound medical practice decrees that there is not time to make such an attempt, to consent to any x-ray examination, anesthetic, medical or surgical procedure, treatment, and/or hospital care, to be rendered to the Registrant under the general or special supervision of and/or on the advise of any physician, surgeon or dentist duly licensed to practice.

The undersigned have read and fully understand and agree to the foregoing.

Insurance Information: Name of Insurance Company:

**Parent/Legal Guardian Signature

ID Number: **No Electronic Signature Permitted

Confirmation Number: _____________________________________________ Date

Original (Team) Copy (Association)

NCYSA COMMUNICABLE DISEASE

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

In consideration of being allowed to participate in any way in any North Carolina Youth Soccer

Association, Inc. (“NCYSA”) related events and activities I, the undersigned participant and parent (or legal

guardian) acknowledge, appreciate, and agree that:

By participating in NCYSA related events and activities, there are certain risks to me arising from

or related to possible exposure to communicable diseases including, but not limited to, the virus “severe

acute respiratory syndrome coronavirus 2, which is responsible for the Coronavirus Disease (also known

as COVID-19) and/or any mutation or variation thereof (collectively referred to as “Communicable

Diseases”). I am fully aware of the hazards associated with such Communicable Diseases and knowingly

and voluntarily assume full responsibility for any and all risk of personal injury, illness or other loss that I

may sustain in connection with such Communicable Diseases.

I, for myself and for my minor child(ren) or ward(s), and on behalf of my/our heirs, assigns,

beneficiaries, executors, administrators, personal representatives, and next of kin, HEREBY EXPRESSLY

RELEASE, HOLD HARMLESS, AND FOREVER DISCHARGE NORTH CAROLINA YOUTH SOCCER

ASSOCIATION, INC. and its officers, directors, officials, agents, representatives, employees, other

participants, sponsors, advertisers, and, if applicable, owners and lessors of premises upon which NCYSA

related events and activities take place (the “Released Parties”), from any and all claims, demands, suits,

causes of action, losses, and liability of any kind whatsoever, whether in law or equity, arising out of or

related to any ILLNESS, INJURY, DISABILITY, DEATH, OR OTHER DAMAGES incurred due to or in

connection with any Communicable Diseases, WHETHER ARISING FROM THE NEGLIGENCE OF THE

RELEASED PARTIES OR OTHERWISE, to the fullest extent permitted by law.

I agree that this Agreement is intended to be as broad and inclusive as is permitted by the laws of

the State of North Carolina, and if any portion hereof is held invalid, it is agreed that the remainder shall

continue in full legal force and effect.

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.

X________________________________________________ ________ _______

Participant’s Signature/Name Age Date

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

REGISTRATION)

I certify that I am the legal parent/guardian with responsibility for the above participant, and that I have read

this Agreement and do consent and agree to his/her release of all the Released Parties as provided above.

I further agree that, for myself, my heirs, assigns, beneficiaries, executors, administrators, personal

representatives, and next of kin, I expressly release and agree to indemnify and hold harmless the Released

Parties from any and all liability incident to the above Participant’s involvement or participation in NCYSA

related events or activities as provided herein, EVEN IF ARISING FROM THE NEGLIGENCE OF THE

RELEASEES, to the fullest extent permitted by law.

X_____________________________ ___________ _________________________

Parent/Guardian Signature Date Emergency Phone Number(s)

CHARLOTTE SOCCER ACADEMY PLAYER & FAMILY PARTICIPATION CONTRACT

By signing this contract, I agree to abide by the following conditions: (Player’s name)

A. Demonstrate appropriate behavior during all team and club events, this includes, but is not limited to practices, games, socials and tournaments.

B. Compete in the spirit of good sportsmanship, review and follow the rules and code of conduct as set forth by NCYSA. The NCYSA code of conduct can be found in the NCYSA Discipline and Appeals Manual. The manual is available on their website, www.ncsoccer.org.

C. Respect my teammates, coaches, referees, opponents, spectators, club and state officials. D. Attend all scheduled practices, games and tournaments (which includes preseason, post season tournaments and State

Cups). In the event of any absence, I will contact the coach and manager in advance to make them aware of my situation.

E. Comply with set tournament rules posted on tournament websites, including state cup series. I understand that I am responsible for my behavior and actions. Poor sportsmanship and inappropriate behavior will not be tolerated. Failure to comply with the above conditions may result in a family fine, my suspension or removal from the team and/or Charlotte Soccer Academy.

(Player's signature) (Date)

By signing this contract, I agree to: (Parent’s name)

A. Review this contract with my child before signing. B. Demonstrate good sportsmanship follow the rules and code of conduct as set forth by NCYSA. The NCYSA code of

conduct can be found in the NCYSA Discipline and Appeals Manual. The manual is available on their website, www.ncsoccer.org.

C. Maintain the highest standard of conduct and respect toward all players, coaches, referees, spectators, club or state officials.

D. Abide by the attached Charlotte Soccer Academy On-Field Spectator Behavior Policy. By signing this contract, I understand that I am responsible for the behavior and actions of myself and all other members of our family and guests. Poor sportsmanship and inappropriate behavior will not be tolerated. I understand the sanctions that will be implemented in the case of violation of this contract and that failure to comply with the above conditions as outlined may result in the suspension or removal of the family from Charlotte Soccer Academy (Parent’s signature) (Date)

This form must be returned with Medical Release and Financial Agreement.

CHARLOTTE SOCCER ACADEMY 2020-2021 FINANCIAL AGREEMENT

Player’s Name:

Parent’s Name(s):

U- _____ Boys/Girls Team Name ______________________ CSA Club Fees $ _________________

Club Fees are paid directly to Charlotte SA and cover expenses such as, but not limited to, field rental, training fees, player registration, additional Charlotte SA training (i.e., speed & agility, technical, goalie, etc.). These fees are set by the association based on the various levels of play offered at Charlotte SA. The fee structures and fee schedules will be posted on the Charlotte SA website. All players new to CSA must purchase a uniform kit through soccer.com.

Team Fees are separate expenses paid directly to your assigned team. The Team Fees cover expenses such as tournaments, referee fees, coach’s travel, team parties/player awards, etc. These fees will vary from team to team and are based on the tournaments and travel your team participates in. The U9/U10 Academy fees are included with the Club Fees.

All expenses to travel with the team to and from practices, scrimmages, games and tournaments are your responsibility. This includes gas, food, room & board, etc.

Agreement By signing this contract, you acknowledge you have read and understand this form and the 2020-2021 Charlotte Soccer Academy fee structure for your level of play in its entirety and agree to the following terms and conditions:

• I understand that my commitment is for the entire 2020-2021 season and that I am obligated to pay all CSA club/team fees for the entire 2020-2021 season.

• As the responsible party, I agree to make all payments to fulfill our financial obligation before or by the due dates listed on the fee chart.

• I understand that if my child quits or leaves the team for any reason or if the season is canceled due to unforeseen circumstances that I remain obligated for all CSA club/team fees for the entire 2020-2021 season. No refunds will be issued. Failure to pay club/team fees will result in my child being prohibited from future tryouts or team selection with CSA until all remaining balances are paid. If the member is delinquent on payments their players pass will be pulled and the player will be placed “Not in good standing”, therefore not allowed to play for CSA until their account is brought to “In good standing” with the club. Any delinquent account is referred to a collection agency for resolution; an additional fee will be added to the balance owed to cover collection agency administrative fees.

• Players will not be released from CSA until their club/team fees have been paid in full. • Returned checks are subject to $25 fee.

Request for release must be presented in writing to kdenner@charlottesocceracademy.com.

Parent/Guardian (Print) __________________________________

Parent/Guardian (Signature) ______________________________

Concussion INFORMATION SHEET

This sheet has information to help protect your children or teens from concussion or other serious brain injury. Use this information at your children’s or teens’ games and practices to learn how to spot a concussion and what to do if a concussion occurs.

What Is a Concussion? A concussion is a type of traumatic brain injury—or TBI— caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells.

How Can I Help Keep�My Children or Teens Safe?�Sports are a great way for children and teens to stay healthy and can help them do well in school. To help lower your children’s or teens’ chances of getting a concussion or other serious brain injury, you should:

• Help create a culture of safety for the team.

o Work with their coach to teach ways to lower the chances of getting a concussion.

o Talk with your children or teens about concussion and ask if they have concerns about reporting a concussion. Talk with them about their concerns; emphasize the importance of reporting concussions and taking time to recover from one.

o Ensure that they follow their coach’s rules for safety and the rules of the sport.

o Tell your children or teens that you expect them to practice good sportsmanship at all times.

• When appropriate for the sport or activity, teach your children or teens that they must wear a helmet to lower the chances of the most serious types of brain or head injury. However, there is no “concussion-proof” helmet. So, even with a helmet, it is important for children and teens to avoid hits to the head.

Plan ahead. What do you want your child or teen to know about concussion?

How Can I Spot a Possible Concussion? Children and teens who show or report one or more of the signs and symptoms listed below—or simply say they just “don’t feel right” after a bump, blow, or jolt to the head or body—may have a concussion or other serious brain injury.

Signs Observed by Parents or Coaches

• Appears dazed or stunned

• Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent

• Moves clumsily

• Answers questions slowly

• Loses consciousness (even briefly)

• Shows mood, behavior, or personality changes

• Can’t recall events prior to or after a hit or fall

Symptoms Reported by Children and Teens

• Headache or “pressure” in head

• Nausea or vomiting

• Balance problems or dizziness, or double or blurry vision

• Bothered by light or noise

• Feeling sluggish, hazy, foggy, or groggy

• Confusion, or concentration or memory problems

• Just not “feeling right,” or “feeling down”

cdc.gov/HEADSUP

Talk with your children and teens about concussion. Tell them to report their concussion symptoms to you and their coach right away. Some children and teens think concussions aren’t serious, or worry that if they report a concussion they will lose their position on the team or look weak. Be sure to remind them that it’s better to miss one game than the whole season.

While most children and teens with a concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your children’s or teens’ healthcare provider if their concussion symptoms do not go away, or if they get worse after they return to their regular activities.

CONCUSSIONS AFFECT EACH CHILD AND TEEN DIFFERENTLY.

What Are Some More Serious Danger Signs to Look Out For? In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body and can squeeze the brain against the skull. Call 9-1-1 or take your child or teen to the emergency department right away if, after a bump, blow, or jolt to the head or body, he or she has one or more of these danger signs:

• One pupil larger than the other

• Drowsiness or inability to wake up

• A headache that gets worse and does not go away

• Slurred speech, weakness, numbness, or decreased coordination

• Repeated vomiting or nausea, convulsions or seizures (shaking or twitching)

• Unusual behavior, increased confusion, restlessness, or agitation

• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously

Children and teens who continue to play while having concussion symptoms, or who return to play too soon—while the brain is still healing—have a greater chance of getting another concussion. A repeat concussion that occurs while the brain is still healing from the first injury can be very serious, and can affect a child or teen for a lifetime. It can even be fatal.

What Should I Do If My Child or Teen Has a Possible Concussion? As a parent, if you think your child or teen may have a concussion, you should:

1. Remove your child or teen from play.

2. Keep your child or teen out of play the day of the injury. Your child or teen should be seen by a healthcare provider and only return to play with permission from a healthcare provider who is experienced in evaluating for concussion.

3. Ask your child’s or teen’s healthcare provider for written instructions on helping your child or teen return to school. You can give the instructions to your child’s or teen’s school nurse and teacher(s) and return-to-play instructions to the coach and/or athletic trainer.

Do not try to judge the severity of the injury yourself. Only a healthcare provider should assess a child or teen for a possible concussion. Concussion signs and symptoms often show up soon after the injury. But you may not know how serious the concussion is at first, and some symptoms may not show up for hours or days.

The brain needs time to heal after a concussion. A child’s or teen’s return to school and sports should be a gradual process that is carefully managed and monitored by a healthcare provider.

To learn more, go to cdc.gov/HEADSUP

Discuss the risks of concussion and other serious brain injuries with your child or teen, and have each person sign below. Detach the section below, and keep this information sheet to use at your children’s or teens’ games and practices to help protect them from concussion or other serious brain injuries.

¡I learned about concussion and talked with my parent or coach about what to do if I have a concussion or other serious brain injury.

Athlete’s Name Printed: Date:

Athlete’s Signature:

¡ I have read this fact sheet for parents on concussion with my child or teen, and talked about what to do if they have a concussion or other serious brain injury.

Parent or Legal Guardian’s Name Printed: Date:

Parent or Legal Guardian’s Signature: Revised January 2019