Player Name - Team - Location (circle one of four) Charlotte, Matthews, North-Cab, Huntersville Birth Year - Boy/Girl 2017-2018 Charlotte Soccer Academy Player Registration Requirements Returning to CSA New to CSA 2 copies 2 copies NCYSA Medical Consent/Waiver of Liability Form Original signature in ink required on one of the forms Sign and submit CSA Player & Family Participation Contract Classic No Youth Academy- Former Rec families SC Only Played in Youth Academy during 2016-17 season Former Rec Player- All- SC Only NEW TO NCYSA New resident to NC Sign and submit CSA Financial Agreement Include the Club fee amount and team name at the top of the Agreement form see fee chart A copy of a Birth Certificate or passport SOUTH CAROLINA RESIDENTS ONLY Signed Interstate Permission Form Attach check for $10 payable to SCYSA Birth Years of 2007-1999 Email photos to photo@charlottesocceracademy.com No hats or sunglasses Players shoulder and up Must be a color photo Send the picture in jpg. File size less then100kb Email Subject - players full name/birth year/location Player location North/Matthews/Charlotte or Huntersville Foreign Born OR Foreign Born US Citizen - ONLY The Soccer Federation is requiring that all foreign born players or foreign born US Citizens complete paperwork and be cleared by the Federation before any player can participate in a competitive program within NCYSA this coming 2017 fall season. If your son/daughter was NOT born in the United States please download and print the required paperwork http://www.charlottesocceracademy.com/default.aspx?tabid=925489 Any questions regarding the forms please contact Tricia Karhnak at registrar@charlottesocceracademy.com All paperwork must be completed yearly DEADLINE for 2017-18 paperwork June 9 2017
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)
Charlotte Soccer Academy On-field Spectator Behavior Policy Due to increased concern from past incidents occurring during league- sanctioned matches and tournaments, the CSA Board of Directors has adopted a new policy directed at sideline spectator behavior. This policy is in affect during competitive games, tournaments and any event where teams are playing under the CSA logo. NCYSA is now clamping down on the abuse to officials and opposing team players and spectators. Punishments for such offences have resulted in the guilty club being fined and having to make all practices and games closed to all spectators. This means that no one is allowed to watch any form of club play during the season. The actions of a few individuals can result in the entire team being punished and the club being placed in bad standing with NCYSA or placed on probation. CSA cannot afford to put their teams or the club in this standing and it will be unfortunate for parents not to be able to watch their children play. We will, therefore, be implementing these new rules and regulations with immediate effect. Any spectator exhibiting unreasonable behavior on the sidelines of any game that result in removal from the field, or being given a warning by any official will be automatically suspended from the next competitive game. This will also result in the suspension of the child from the first half of the following competitive game. A second offense will result in automatic expulsion from Charlotte Soccer Academy. Unreasonable behavior is defined as any use of profanity or confrontation toward officials, opposing players and opposing spectators that results in the disruption of the game. CSA cannot and will not allow this type of behavior to escalate to a point where NCYSA is required to impose sanctions. Having a child suspended for the first half of a competitive match due to poor spectator behavior on the sidelines would be extremely unfortunate. As a club, we feel that due to the severity of this issue across the state and within our organization, it is necessary for CSA to enforce this type of punishment in hopes that it will deter any and all poor behavior from the sidelines. We hope this policy will never have to be implemented and parents or spectators alike can enjoy the great game of soccer while watching their child develop and grow as a player. CSA appreciates everyone s understanding and cooperation with this matter. Brad Wylde Executive Director, Charlotte Soccer Academy Jim Cantalupo President, Charlotte Soccer Academy Adopted March 2012
CHARLOTTE SOCCER ACADEMY PLAYER & FAMILY PARTICIPATION CONTRACT By signing this contract, I (Player s name) agree to abide by the following conditions: 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 (Parent s name) agree to: 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 2017-2018 Club Fees Fee Schedule Playing Level Season Yearly Club Fee Commitment Fee due on acceptance Payment Due August 1 Payment Due October 1 Payment Due January 15 1 9U/10U Academy Boys & Girls Full Year $850 $300 $275 $275 2 11U/12U Classic Boys & Girls Full Year $1,200 $300 $300 $300 $300 3 12U Classic OPEN Boys & Girls Full Year $1,350 $300 $350 $350 $350 4 13U/14U Classic Boys & Girls Full Year $1,325 $300 $340 $345 $340 5 13U Classic OPEN Boys & Girls Full Year $1,495 $300 $395 $405 $395 6 14U Premier and SRPL Boys & Girls Full Year $1,625 $300 $440 $445 $440 7 15U-19U Classic Girls Fall Only $1,150 $300 $425 $425 8 15U-19U Premier and SRPL Girls Fall Only $1,475 $300 $587 $588 9 15U-19U Classic Boys Spring Only $1,150 $300 $425 $425 10 15U-19U Premier Boys Spring Only $1,475 $300 $587 $588 11 15U-19U Premier and SRPL Boys Full Year $1,625 $300 $440 $445 $440 12 U14, U15, U16/17, U18/19 US Soccer Development Academy Girls Full Year See US Soccer Development Academy Website and Player Packet 13 U12, U13, U14, U15, U16/17, U18/19 US Soccer Development Academy Boys Full Year See US Soccer Development Academy Website and Player Packet The commitment fee is non-refundable. Upon commitment to a team, you are financially responsible for all Club fees for the entire playing year. CSA Club Fees Include: NCYSA registration and insurance. Field maintenance and lighting costs. Supplemental technical, speed & agility, & goalkeeper training. Administrative costs. Field usage fees. Minimum of 2 team training sessions per week for Classic teams with qualified coaches. Minimum of 3 team training sessions per week for Premier/SRPL teams with qualified coaches. Minimum of 3 team training sessions per week for 12U & 13U OPEN teams with qualified coaches. CSA Uniform Policy: All CSA players must purchase a uniform kit decorated with CSA logos and jersey # through the online ordering system at www.soccer.com. Specific instructions will be distributed after tryouts. Both the Adidas field and goalkeeper uniforms include 2 game jerseys, 2 shorts, 2 pairs of socks and 2 Adidas training jerseys. The price is approximately $200. Uniforms purchased this year will be utilized for the 2017-18 and the 2018-19 seasons. USSDA players refer to the USSDA player packet for details on uniforms. Club fees for schedules #2 through #11 above do not include team fees for referees, tournaments, etc. which are paid directly to the team. This is an additional cost. Players will not be released from CSA unless all Club fees are paid in full and team fees are up-to-date at the time of the request. Players with a season ending injury may be eligible for a refund or credit with the amount to be determined on a case-by-case basis. Players moving more than 50 miles during the season are eligible for a refund with the amount to be determined on a case-by-case basis. Requests for releases and withdrawals must be presented in writing to kbarker@charlottesocceracademy.com. All fees must be paid on the payment due date. Statements will not be mailed. Parents are encouraged to take advantage of the auto draft function offered during the registration process. Any payments that are delinquent may be cause to suspend a player from participation in CSA activities. If this should occur, a service charge of $50 to reinstate a player may be charged. Returned checks are subject to a $25 fee. Following a returned check, additional payments must be made in cash or by credit card.
CHARLOTTE SOCCER ACADEMY 2017-2018 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 prior to May tryouts, and one is also included in the tryout information packet. All players new and returning 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 amount of 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. For ECNL and Development Academy teams, please refer to your fee schedule for travel fee details. Agreement By signing this contract, you acknowledge you have read and understand this form and the 2017-2018 Charlotte Soccer Academy fee structure for your level of play in its entirety and agree to the following terms and conditions: The commitment fee is non-refundable. Upon commitment to a team, you are financially responsible for all Club fees as stated for the ENTIRE PLAYING YEAR even if your child drops out during the year. Players will not be released from CSA unless all Club fees are paid in full and team fees are up to date at the time of the request. Players with a season ending injury may be eligible for a refund or credit with the amount to be determined on a case-by-case basis. Players moving more than 50 miles during the season are eligible for a refund with the amount to be determined on a case by case basis. Requests for releases and withdrawals must be presented in writing to kbarker@charlottesocceracademy.com. All fees will be paid when payment is due. Statements will not be mailed. Any payments that are delinquent may be cause to remove player card from the team. If this should occur, a service charge of $50 to reinstate a player card may be charged. Returned checks are subject to a $25 fee. Following a returned check, additional payments must be made in cash or credit card. (Parent Signature) (Date) (Print Parent s Name)