Program Registration Form

Upon filling out and SIGNING the following form with your computer
please print it out and mail it along with your SIGNED waiver to:
New Vision Athletics, PO Box 216, Lake Bluff, IL 60044
OR FAX to: 847-615-0234
If you have any questions please feel free to contact the hotline at 847-295-0682

You may also download the registration form and waiver by clicking here.

Family Information:
Family Last Name:
Home Phone: Home Fax:

(Please Note: If you know we already have the below information on file and there have been no changes there is no need to fill out the next part.)

Address: City, State, Zip:

Father's Name Father's Work Phone: Father's Cell Phone:
Mother's Name Mother's Work Phone: Mother's Cell Phone:

Alternate Emergency Contact, Relationship, Phone

(If separated of divorced please list spouse or former spouse's information)

Name & Phone:
Address: City, State, Zip:
Check here if you would like us to send a copy of Schedule Information to the above listed individual?
Please select the program you are registering for:
Child's Name Grade School Your Child Attends Birth Date Football Only -Child's Weight Program Description

Program
Fee


Form of Payment: Payment Terms:
If paying by check please list check number and amount:

Check # Amount $
Credit Card: Card #: 3 Digit Code Exp. Date:

Signature: _________________________________________
Please note that this website is NOT an online commerce site and will not be processing your credit card information. These lines are here simply for your convenience.

Notes / Long Vacation Periods / Requests*
*Please note that requests are primarily for Level 1&2 (kindergarten, 1st & 2nd grades) programs where no scores or standings are kept.
NEW VISION ATHLETICS UNIFORM AGREEMENT

Uniforms are property of New Vision Athletics. Participants have the option to purchase his or her uniform at the season's end for the amount listed below. Failure to return the uniform in the manner set forth below shall be a basis for immediate uniform charge to the credit card number listed below in the amount of $50 for soccer and $150 for football..

IF YOU DO NOT WISH TO SUPPLY CREDIT CARD INFORMATION AS A DEPOSIT, A SERARATE UNIFORM DEPOSIT CHECK MUST BE PROVIDED FOR THE AMOUNT BELOW.
Checks will be torn up when uniform is returned. Credit cards will not be processed unless the following conditions are not adhered to:
A. Uniform shall be laundered and returned in the same condition as issued.
B. Uniforms shall be returned no later than TWO WEEKS from the conclusion of our Awards Night
C. No names may be added to the jersey. If a name is added, the uniform will be considered a purchase.

I hereby authorize N.V.A. to charge the below listed card for $50 per uniform for soccer $150 for football pertaining to the conditions described above.

Signature: __________________________________________ Date: _____________
Credit Card Number: Expiration Date:

Consent, Assumption of Risk Statement & Release of Minor Participant

(This form must be mailed or faxed to N.V.A. and cannot be submitted online.)

I, the parent or legal guardian of  ________________________________________ consent to allow this minor individual to participate in the New Vision Athletics Soccer or Football Program with New Vision Athletics, Inc. ("NVA" herein) at Lake Forest College, Lake Forest Country Day School, School District 65 and or at any other location at which NVA may offer it's sport's program.  I have read and understand the Consent, Assumption or Risk & Release Statement, and intend to and by signing bind myself, my spouse, the minor and my and the minors heirs, successors, executors, estate and dependents to the terms hereof.

I will advise the minor that he or she must inspect the equipment, gym, swimming pool, playing field to be used and if the minor believes anything is unsafe, the minor shall immediately advise the program supervisor present and refuse to participate further.

I agree that I will advise the minor of all safety procedures in using the equipment, gym, swimming pool and playing fields and will instruct the minor to follow them.

I will advise the minor to not attempt any skill level training or any other activity of which the minor is not fully capable. I realize that the study of sports activities requires proper conditioning and training.

I understand that sports activities are an education system. I agree that the minor will strictly abide by the training rules of NVA and will follow explicitly, all instructions given by the instructors during the course of the minor's training. I will advise the minor to watch out for others in the course of the minor's training and to follow all rules posted or otherwise explained to him or her.

I fully understand that:

A. There are risks and dangers associated with sports activity training, but not limited to bodily injury, communicable diseases, partial or total disability, paralysis and death.  In accordance with the law, NVA does not exclude individuals with medical conditions that do not pose a medically recognized threat to the health or safety of other participants in the normal course of play.  I understand that there are some unavoidable circumstance where these conditions may require special caution on the minor's part to minimize the danger to the minor or others, and I acknowledge that it is the minor's responsibility to act accordingly.

B. There are social and economic losses ands damages which could result from those risks and dangers described above which could be severe;

C. There are other risks not known or foreseeable at this time that could arise.

I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISKS TO THE MINOR OF DEATH, ILLNESS OR INJURY SUSTAINED WHILE PARTICIPATING IN OR OBSERVING NVA SPORTS PROGRAMS WHETHER OR NOT CAUSED BY NEGLIGENCE OF THE RELEASED PARTIES DESCRIBED HEREIN.

I accept and assume all risks and responsibilities for all losses and damages following an injury, illness, disability, paralysis or death, however caused or alleged to be caused, including injuries caused in whole or in part by the negligence of NVA, it's representatives, agents employees, instructors or participants.

I release NVA, Lake Forest College, Lake Forest Country Day School, School District 65 and it's instructors and guest instructors, representatives, agents, employees, and all individuals associated with NVA including all officers, directors, agents and employees of Lake Forest College (herein after referred to as "the Released Parties" of and from any and all liability, claims, demands or actions whatsoever arising out of any damage, loss, or injury to the minor while participating in NVA Sport's Program or any other related activity of NVA, whether such loss, damage or injury results from negligence or otherwise.

I agree this Release covers each and every time the minor plays or otherwise participates in any activity, listed or unlisted, of NVA at Lake Forest College facilities, Lake Forest Country Day School facilities, School District 65 facilities and any other location sponsored by NVA and it's agents, representatives or instructors.

I agree that I will not sue or make claims against the Released Parties as a result of the minor's participation in the NVA Sports Program or activities at Lake Forest College Facilities, Lake Forest Country Day School Facilities, School District 65 Facilities or any other locations where participation takes place.  I agree to indemnify and hold harmless the Released parties from all claims, judgments and costs including attorney's fees incurred in connection with and any such action brought as a result of the minor's participation in any NVA activity.

In signing this Release, I am stating that I know what I am doing, and that I take responsibility for the minor's acts, that I have read carefully and understand this Release and fully agree with each statement contained herein and that I am responsible for the minor, I am aware that I may have the Release reviewed by legal counsel.

If any portion of this Release shall be held to be invalid, illegal or unenforceable to any extent and for any reason by any court of competent jurisdiction, the remainder of this Release shall not be affected thereby and shall be enforceable to the full extent permitted by law.

I sign this Release on behalf of myself, my spouse, the minor, and my minor's heirs, successors, executors, estate and dependents.  I hereby acknowledge that I am an adult, 18 years or older.

__________________________________________ ________________________________________________ ____________
Parent or Guardian's Name (printed) Parent or Guardian's Signature Date
Address of Participant(s): ________________________________________________