GEORGIA RUSH MEDICAL RELEASE FORM

I,_____________________________ (Parent/Guardian's Name) hereby give permission for any and all medical attention to be administered to my child ____________________________ (Child's Name) In the event of accident, injury, sickness,etc., under the direction of the person(s) listed below, until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment. This release is effective for the period of one year from the date given below.ADDRESS: _____________________________________________________________ ______________________________________________________________________HOME PHONE: __________________________________________________________INSURANCE COMP:_______________________________________________________POLICY NUMBER: _______________________________________________________In case I cannot be reached, any of the following persons is designated to act on my behalf.* COACH: __________________________________________________________* ASST.COACH: _____________________________________________________* MANAGER: ________________________________________________________* A league representative where my child is playing.* Any tournament representative where my child is participating in a tournamentPHYSICIAN: ___________________________________________________________ADDRESS: _____________________________________________________________PHONE: _______________________________________________________________KNOWN ALLERGIES: _____________________________________________________

SIGNATURE (PARENT/GAURDIAN) _______________________________DATE ____________

Subscribed and sworn before me,this ______ day of __________________ , 20 _____________________________________________________Notary Public

GEORGIA RUSH

PLAYER COMMITMENT TO EXCELLENCE!CONGRATULATIONS! You have been selected to become a member of GEORGIA RUSH for the 2016/2017 Fall/Spring soccer season. As a member of GEORGIA RUSH, you will play other Academy and Select teams in the Metropolitan Atlanta area as well as other teams from other cities in Georgia, participate in area (and perhaps national) tournaments with other competitive teams, and possibly compete for the State of Georgia championship in your age division. You will practice on the finest practice facility in the North Fulton area under the supervision of a group of dedicated coaches and staff.At this level of competition, the difference between being ordinary and being extra-ordinary is a little extra effort. Success and fun on the soccer field comes with the willingness to not say “I can’t” but instead “I will try my best”. The will to win is not enough; you must also have the will to prepare to win. We are speaking of more than just the effort it takes to show up at the soccer field on the day of the game. We are talking now about the kind of effort that involves some hard work, some choices about the way in which you wish to spend your free time, and perhaps some sacrifices on your partConsider carefully the following commitments that each team member must make:1. I promise to arrange my schedule so that I can come to practice regularly and on time, and to participate in scheduled games and tournaments.2. I promise to work hard at practice to improve my soccer skills and my understanding of the game.3. I promise that, at practice, I will give the coaches my full attention. When the coaches are talking, I will stop talking, keep my ears open, and my eyes on the coaches. I will not distract others during the practice session.4. I promise to do whatever is asked of me on the soccer field, without complaining, for the good of the team.5. I promise always to encourage, and never to criticize, my teammates.6. I promise always to hustle, and never to quit, until the game is over.7. I promise to come to each game, on time, well rested, and with an attitude that says -- "It may be difficult, but believe that we can win."8. I promise to uphold the 11 Rush Core Values (attached document)9. I understand that player conduct is observed on an individual basis. Any conduct deemed inappropriate will be addressed first with a verbal warning. If the misconduct continues, based on Coach determination, resulting actions could range from individual practice and game penalties to Club suspension.If you are not willing to make this commitment, then perhaps you should reconsider your decision. If you are willing to make this commitment, then we believe that we can help you become a better soccer player and a contributing member of a competitive soccer program. As coaches and staff, we commit to you that we also will work hard to help you improve your skills, gain in your knowledge of the game, and make practices a worthwhile experience.People very seldom are successful at anything unless they can have fun doing it. We will expect you to work hard, but we will make every effort to see to it that you have fun also.

_____________________________ ____________________________Player Signature Parent Signature

Revised 5/15/2015

HUMAN RESOURCES

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RUSH CORE VALUESAccountability: Be accountable for your actions and hold others accountable for their actions. Who am I ultimately accountable to, and who judges my work?Advice: Seek out advice and aspire to be the best. In order to learn, we must be open to learning and consider the advice of others. Are you coach-able?Empathy: Empathy is at the core of solid relationships.Enjoyment: Enjoy your work, this is a gift. The desires of diligent workers are satisfied.Humility: Apologize when you make a mistake. Forgive others and do not look back.Leadership: Leaders strive to be trustworthy, honest and sincere. They possess traits such as integrity and honor. They are willing to serve others and sacrifice their own interests. Leaders are constructive and hardworking.Passion: Passion always trusts, always hopes and always perseveres. Passion never fails.Respect: Respect everyone. Respect the opponent, the rules, your colleagues, your superiors and subordinates. Be thoughtful and considerate.Safety: Our environment is safe. This includes the office, our travels, the fields and our bodies. Safety is not only physical safety from harm, but safety from ridicule and attack. We are comforted and encouraged in the club. We portray self-control and kindness to our staff, our colleagues and players.Tenacity: To be successful, persevere.... persevere but do not be anxious. Fear no one. Be strong and courageous. Work when no one is looking, even when the circumstances are not right and everyone else quits. Diligence never loses because it never quits. Out work your opponent, and most importantly, work smart. Don’t wait for external inspiration. The people who go far do so because they motivate themselves and give life their best, regardless of how they feel.Unity: Together all things are possible. When your teammates are down, bear each other’s burdens; conversely, celebrate your teammate’s successes.

125 113 Copyright © 2003, Rush Soccer September 2, 2010

GEORGIA RUSH PARENT CODE OF CONDUCT

OPTIMIZING PARENTAL PERFORMANCE…

Soccer games/practices are as exciting for some parents as they are for their children. They want to support the team, cheer for the team, and encourage their child. Occasionally, this enthusiasm combines with a parent’s lack of familiarity with the game, or lack of knowledge of the coach’s instruction to the team, in a way that causes

problems.

We do not wish to curb your enthusiasm for the game. We do wish to make sure that your enthusiasm is channeled in a way that will be helpful, complies with the rules of the game, and is consistent with the coach’s instruction to the team. In this spirit, please keep these suggestions in mind as you attend Georgia Rush games.

LET THE COACHES COACH: This includes goal setting and psyching up your child for practice and post games and post game critiques. Having more than one “coach” confuses children. When your child is unclear about anything a coach is telling them encourage them to talk with their coaches and let them take the responsibility for understanding what is being communicated.

ENCOURAGE –DO NOT CRITICIZE: One of our goals is to help your child play good soccer. No less important is our goal to make every effort to insure that your child has fun. Your child understands the Club’s high expectations on him or her and feels the peer pressure to do well. You can best help by confining your talk during the game to positive encouragement. Support your child unconditionally. Do not bribe or offer your child incentives for goals of field play. This distracts your child from concentrating properly in practices and games.

DISPLAY APPROPRIATE “PARENTAL” BEHAVIOR AT PRACTICES AND GAMES: Do not yell your child’s name. Please say, “go team” or “good goal”. Cheering for your child is distracting to them and we want to encourage a team effort. Support all players on the team – each child has the opportunity to learn from their peers.

KNOW SOMETHING ABOUT THE RULES OF THE GAME: Sometimes, parental ill will toward the referee or a player is based upon a parent’s ignorance of the rules of the game. Common problems are the understanding and application of the rules governing offsides and illegal contact. For more information visit the GYSA website, under documents, rules and regulations, you will find the Laws of the Game.

DO NOT YELL AT THE REFEREE: It is our goal to build not only good soccer players, but also good sportsmen. Your positive or negative example at games will either greatly reinforce, or significantly undermine that effort. The coach or team captain has principal responsibility, although limited latitude in speaking with the referee. Let them do their job when and if they feel it is necessary. With respect to tournament play, often times one tournament team is given a special award for good sportsmanship. Your yelling and screaming could rob the kids of an opportunity to earn such an award.

KEEP REALITY IN FOCUS: Remind your child to focus on the process, not the end result. Some loses are “wins” based on team performance and some wins are “loses: for the same reason.

SUPPORT THE PROGRAM: Get involved by volunteering, for your team and club in any way you can. The more involved you are with your club and team the more your child will know you are supporting their interest

SUPPORT AND UNDERSTAND “The Rush Way” and the 11 Rush Core Values.Any actions or behavior which is not in keeping with the Georgia Rush Parent Code of Conduct and/or club philosophy should be reported to the Academy/Select Director. The matter will then be directed to the Georgia Rush Disciplinary & Grievance Committee for further action.

2016-2017 Registration* & Fee ScheduleAcademy, Athena, Classic, & R3PL

CONVENIENT MONTHLY PAYMENTS AVAILABLE

**Tournament and Uniform fees not included

Player Name__________________ Age Group U-______

All registration and payments must be initiated by the customer online atwww.georgiarush.com or in person on signing day. (U9-U13 June 9, U14 and older June 16)

Every player must have a signed Payment Commitment Form selecting aPayment Plan turned into the club to receive a player card. Payment Commitment Form and deposit or payment in full is due by June 30, 2016.

All Fees Include:

Registration and Administration Fees of $350.00 Coaching fees for team practices and seasonal games (Fall 2016/Spring 2017)

Three nights of team training Goalkeeper Training Summer Team Camp (prior to the start of the regular practice season)

HS Teams Spring Season Practices Academy – one night of Elite Technical Training Select - one night of specific Speed and Agility for soccer with Peak Performance Functional Training for U15 and above (February to April)

Once signed with Georgia Rush:

I understand that if I take advantage of any of the extended payment plans, post-dated checks or credit card authorization will be required Credit card payments and post dated checks will be processed on or within fourteen days of payment due date. A late fee of $25 may be assessed for any fees not paid by due date. A $25 NSF fee will be assessed for each returned check.

I hereby give approval for the participation of my child in any of the programs held at Stars S, Soccer, Inc, DBA Stars Athletic Club home of Georgia Rush Soccer Academy, DBA Georgia Rush Soccer Club.  I understand that participation in these programs may involve risk ofinjury.  As a parent, guardian, or participant I am aware of these hazards and my child’s ability to participate.

I agree for myself, my heirs, executors and administrators to waive and release any and all claims of damage; absolve, indemnify and agree to hold harmless; Stars Athletic Club, Georgia Rush Soccer Club it successors and assigns, organizers, supervisors, officers, directors, employees, agents and representatives for any and all kinds of injury including but not limited to transportation to and from said activities and personal injury and/or property damage suffered by my child or myself, or my ward, while participating in this activity.

I understand that a player who registers with an affiliated GSSA league is bound to that league for the entire 2016/2017 seasonal year (Both Fall and Spring Seasons).  **I further understand that tournament team expenses are the responsibility of every player on the team, regardless of whether or not they are able to attend the team tournament. Uniform expenses are the responsibility of each individual player.

In addition, I give my permission for my child to be treated by qualified medical personnel in the event that the named parent/guardian cannot be reached at the phone number provided. I also understand and accept that e-mail will be used as the primary form of contact , except in the case of medical emergency.  I give permission to use my child’s photo in any club marketing materials.

REFUND POLICY: Georgia Rush Soccer Academy has a no refund policy.*No credit for missing any programs or practices. 

____ I have read the above rules and agree.

________________________________________ ___________________________________________Signature of Individual Responsible for Payment Printed Name of Individual Responsible for Payment

________________________________________ _______________________________________ E-mail address Phone Number

Locate your age group and playing level and place a check mark in the agreed payment plan below. Some payment plans include a small service charge for additional processing and credit loaned by Georgia Rush.

**U9-U12 Academy ($350 Registration/Administration Fees $1250 Player/Club Fees)

______ Option 1: Deposit of $400 due on June 9; Five payments of $ 245 due on the 15 th of the month beginning

July 15th – November 15th

_____ _ Option 2: Two payments of $ 800 each due on June 9 and January 15

_______Option 3: Pay in full: $1575 discounted rate June 9 – June 30 – ONLY!

**U13-14 Select ($350 Registration/Administration Fees $1250 Player/Club Fees)

_____ _ Option 1: Deposit of $400 due on June 9 (U13) and June 16 (U14); Five payments of $ 245 due on the 15th of the

month beginning July 15th – November 15

_____ _ Option 2: Two payments of $ 800 due on June 9 (U13) and June 16 (U14) and January 15

_______Option 3: Pay in full: $ 1575 discounted rate June 09 - June 30 (U13) and June 16 – June 30 (U14) – ONLY!

**U15-19 Select ($350 Registration/Administration Fees $850 Player/Club Fees)

_____ _ Option 1: Deposit of $400 due on June 16 ; Five payments of $ 165 due on the 15th of the month beginning

July 15 th – November 15th

______ Option 2: Two payments of $ 600 due on June 16 and September 15

_____ _ Option 3: Pay in full: $ 1175 discounted rate June 16 – June 30 – ONLY!

***Please choose a payment method below: (Credit Card or ACH Debit Authorization required if not paying for the year in full)

All credit card payments will incur a convenience fee. We accept Visa, MasterCard, and American Express. There is a processing fee credit cards.

______Credit Card Number _______________________________ Expiration Date_______

3 Digit Security code______________ Zip code for card payment_______________________

Printed name on Credit Card_________________________________________

Billing address for credit card if different from your address listed in Blue Sombrero:

_____________________________________________________________________________

_____ ACH Debit Authorization Form

________________________________________ ___________________________________________

Signature of Individual Responsible for Payment Printed Name of Individual Responsible for Payment

***It is the customer’s responsibility to report to Georgia Rush any problems with credit cards, such as lost or stolen cards, updated credit card expiration dates, and problems with banking accounts associated with post-dated checks. Thank you!

5/15/205