ALTIVUS Soccer Academy

Program Registration

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This registration, its agreements, and payment will be saved to the selected player.

1. Player Information

Player full legal name *Date of birth *Age *GenderCurrent schoolCurrent team/clubPrimary positionSecondary positionYears playing soccerJersey/shirt sizeID type *ID / document number *

2. Adult Player / Parent / Guardian Information

Full legal name *Relationship to player *Phone *Email *Home address *City / State / ZIP *

3. Emergency Contacts

Contact other than parent *Relationship *Primary phone *Alternate phone

4. Medical & Allergy Information

Does the player have any allergies? *

Allergy, severity, reaction and exposure instructions

Medical conditions ALTIVUS should know about? *

Condition, warning signs, triggers, restrictions and emergency instructions

Does your child use or carry an inhaler? *

Yes No

If yes, provide the inhaler name/type, when it is used and where it will be kept during ALTIVUS activities.

Does your child require an EpiPen or epinephrine auto-injector? *

Yes No

If yes, explain where it will be kept during ALTIVUS activities.

Does your child take medication or require other emergency/rescue equipment? *

Yes No

If yes, list the medication or equipment and provide clear instructions for its use.

Are there physical restrictions, accommodations or other health/safety information our coaches need to know? *

Yes No

If yes, explain the restriction, accommodation or relevant safety information.

6. Assumption of Risk & Liability Release

REQUIRED: I am the adult player or the parent/legal guardian of the minor player. I have read and agree to the ALTIVUS Assumption of Risk & Release of Liability. I understand that participation in soccer and athletic activities involves risks of injury and that this agreement contains a release of certain legal claims, including claims involving ordinary negligence, to the fullest extent permitted by Texas law.Signer initials *

7. Emergency Medical Authorization

REQUIRED: I authorize ALTIVUS to contact 911/EMS when reasonably necessary. If I cannot be reached promptly, I authorize emergency evaluation, transportation and treatment of my child by qualified emergency and medical personnel as described above. REQUIRED: I certify that I have disclosed my child’s known allergies, medical conditions, inhaler/EpiPen or other rescue equipment, relevant medications, restrictions and emergency instructions. I agree to notify ALTIVUS if this information changes.

8. Photo/Video Choice

Permission is not required to participate, but you must choose Yes or No.

YES — I give permission for ALTIVUS Soccer Academy to photograph/video my child and use their image, likeness, voice and/or first name for ALTIVUS social media, website, advertising, flyers, academy announcements and other promotional materials. NO — I do not give permission for my child to be intentionally featured in ALTIVUS promotional photography/video.

9. Refund, Cancellation & Makeup Policy

Review the complete ALTIVUS Refund, Cancellation & Makeup Policy.

REQUIRED: I have read, understand, and agree to the ALTIVUS Soccer Academy Refund, Cancellation & Makeup Policy, including the applicable cancellation deadlines and non-refundable fees.

10. Electronic Signature

Electronic Signature & Adult Player / Parent / Guardian Certification

I certify that I am the adult player, or the parent or legal guardian of the minor player, named in this registration and that the information I provided is accurate and complete. I acknowledge that I have had the opportunity to read the agreements presented with this registration.

By typing my full legal name below and submitting this registration, I intend to electronically sign the agreements I accepted.

Signer Full Legal Name (Electronic Signature) *Email address *Today’s date *

REQUIRED: I understand that typing my name above and submitting this registration constitutes my electronic signature.

11. Payment

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Coupon code (optional; cannot be combined with prepaid savings)Unclaimed gift certificate code (optional)

Gift cards already claimed to your ALTIVUS account are applied automatically. Other valid discounts and gift-certificate balances are applied securely at checkout.

YES — I understand that the enrollment fee and first membership payment are due when I register.

Your information and accepted agreements will be securely recorded before you continue to payment. Registration is complete only after payment succeeds.

Program Registration

Game kit

Training kit

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1. Player Information

2. Adult Player / Parent / Guardian Information

3. Emergency Contacts

4. Medical & Allergy Information

5. Membership Options

6. Assumption of Risk & Liability Release

7. Emergency Medical Authorization

8. Photo/Video Choice

9. Refund, Cancellation & Makeup Policy

10. Electronic Signature

Electronic Signature & Adult Player / Parent / Guardian Certification

11. Payment