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2024 Coed Soccer Registration

2024 Hickman Area Soccer Registration Pre-K-3rd

Hickman Parks & Recreation Department
P.O. Box 127, Hickman, NE 68372
www.hickman.ne.gov

Participant Name  Date of Birth  Age 

Sex: M F

Current Grade in 2024 

Special Request Coach or one child, please)  

Parent Name  E-Mail Address

Address City State Zip

Phone Number: Home  Cell   Work  

I'm interested in Coaching Name  Email 

DISCLAIMER: DUE TO NEW GRASS, NO CLEATS ARE PERMITTED FOR ALL AGE DIVISIONS.

Late Fee of $15.00 Will Apply to Registrations Received After July 31, 2024
NO REGISTRATIONS WILL BE ACCEPTED AFTER August 9, 2024, at 5:00pm
Financial Assistance Program May Be Available

NOTE TO PARENT/GUARDIANS: Due to the complexity of team creation, equity, scheduling, uniforms, pictures, etc., player and/or team adjustments will not be made after late registration deadlines. Waiting lists are available after late registration has closed in the event of a last-minute cancelation. Spots on the waiting list are first come first served and a spot on a team is not guaranteed.

Please note, the Youth Coed Soccer Season and Youth Coed NFL Flag Football Season overlap, and games could be held at the same time due to limited field availability. Games may be held on additional weekdays or over the weekend based on registration amounts. No games will be held on Wednesdays or Sunday Mornings.

$45 Coed Soccer grades Pre-K to 3rd Grade for the 2024/2025 school year, payable to the City of Hickman   *WITHOUT REVERSIBLE JERSEY*

$65 Coed Soccer grades Pre-K to 3rd Grade for the 2024/2025 school year, payable to the City of Hickman   *INCLUDES REVERSIBLE JERSEY*

T-Shirt Size: (Check One)

Youth:  S (6/8)    M (10/12)     L (14/16)

Select here if you DO NOT give permission for your minor child/ward(s) picture(s) to be on the City of Hickman Facebook, Website and/or Newsletter.

 

Please Select an Age Division:

Pre-K to Kindergarten Division

1st  to 3rd Grade Division

 

 I have read the Parent/Athlete Concussion Information Sheet

 WAIVER AND RELEASE OF LIABILITY    

   

Please read this form carefully and be aware that in participating you will be waiving and releasing all claims for injuries that you or your minor child/ward might sustain arising out of this participation.

 

As a participant or parent/guardian of a participant, I recognize and acknowledge that there are certain risks of physical injury and agree to assume the full risk of any injuries, including death, damages or loss which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with this program. 

 

I agree to waive and relinquish all claims I or my minor child/ward may have against the City of Hickman and its officials, officers, agents, servants and employees as a result of participating.  I do hereby fully release and discharge the City of Hickman and its officials, officers, agents, servants, employees and volunteers from any and all claims from injuries, including death, damage or loss which I or my minor child/ward may have or which may incur or may accrue to me or my minor child/ward on account of my participation.

 

I further agree to indemnify and hold harmless and defend the City of Hickman and its officials, officers, agents, servants, employees and volunteers from any and all claims resulting from injuries, including death, damages and losses sustained by me or my minor child/ward and or arising out of connected with, or in any way associated with the activities of my participation.

In accordance with Nebraska Statute 71-9105 (2011), parents and coaches must review the provided items that address the following:

  1. The Signs and Symptoms of a Concussion;
  2. The Risks Posed by Sustaining a Concussion; and,
  3. The Actions an athlete should take in response to sustaining a concussion, including the notification of his or her coaches.

(More information is available at www.cdc.gov/concussion/HeadsUp/youth.html)

By signing this form I acknowledge that I have read and fully understand the above warning of Risk and Waiver and Release of All Claims and have received information in accordance with Nebraska Statute 71-9105 regarding concussions.

 

Parent/Guardian Electronic Signature (Required)      Date 

 

 

 

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