If you have any questions about this form please email: arlingtoncoedkicks@gmail.com

Player Information

Previous Season *

Current Season

First Name *

Last Name *

Date of Birth: * +

Gender *

Player Status *

Street Address *

City *

State *

Zip Code *

Phone Number

Team Name or Free Agent: *

New Team Name

Were you on an ACK roster in 2022? *

Yes

No

Unsure

Previous Team Name: *

Previous Team name (if not listed in dropdown) *

Player Email Address (note that the league may send email communication to this email address) *

Confirm Player Email Address *

Skill Level: *

Beginner

Intermediate

Advanced

Free Agent Info: Please describe your Highest Level of playing experience as well as any other information you would like to share with team captains looking for new players. Include the positions you like to play and any other leagues you have played in recently. *

How did you find out about the league? *

If Other, please describe: *

Arlington Residency Information

ACK uses fields located in Arlington County and as part of the requirement for using the fields, the league is required to fulfill residency goals set by Arlington County. Please answer the questions in this section to determine if you qualify for Arlington Residency. Non-residents and Business residents are subject to a $30 per player additional fee. Your team captain will be collecting this from you.

Residency Type: * 🛈

I am an Arlington County Resident	I am employed and/or I have a spouse that is employed by Arlington County (County Government or ACPS School)
I work or go to school in Arlington County (Business Resident) - Business Residents are subject to the $30 out of county fee. This is payable to your captain	I do not qualify for Arlington Residency

Proof documentation - if you are an Arlington County Resident please check the box next to the proof you are providing. You can go to this link for more information: Documents that establish proof of residency. * 🛈

1. Copy of current VA drivers license/ID card with address that matches registration address

2. Copy of current utility bill (most be within the most recent month)

3. Copy of current voter registration card

4. Copy of current lease (must not expire before the season starts and needs signatures)

5. Any legal documentation that has a current date and includes current address that matches registration address

6. Arlington County Tax Bill (must be the current tax year)

Please name the Arlington County Department or School you or your Spouse works for. Include the name of your spouse if your spouse is employed by Arlington County * *

Name and address of the company you work for or school that you attend in Arlington County. * *

Proof documentation - if you are an Arlington County Business Resident please check the box next to the proof you are providing. For more info see: Documents That Establish Proof of Arlington Residency or Arlington Property Ownership * *

Pay stub showing the employee’s name and the name and address of the employer, dated within the past 4 months, along with a copy of the participants government issued ID.

Statement of employment on company letterhead with the personnel director’s or president’s signature, dated within the past 4 months, along with a copy of the participants government issued ID.

Please attach a proof of residency document. Please make sure scans are clear and legible. Recommend photographing your ID and attaching the photo as an attachment. (VA Drivers licenses do not photo copy well). If you are employed by Arlington County, include a copy of your badge or paystub. If you are a business resident, please include a copy your last pay stub (please remove any sensitive information) or a copy of current class schedule.

Name your file with your Team Name/Last Name/First Name/and then the type of document (ex. Arlington United - Somvang, Suda - ID) * 🛈

FEE: Please pay your fee to your team captain.

SUB list: Free agents and ACK league members on a team that has fulfilled all registration requirments are eligible to join a sub list for substituting on other ACK teams. If you are interested in joining this list, please enter the email address you would like to get notifications to below. (NOTE: You will be added to a listserv and recieve all sub requests.)

Do you want to sign up for the sub list? *

What email do you want sub requests to go to? *

Waiver

As consideration for the right to participate in the "Arlington Coed Kicks" and/or other activities and services provided by the Arlington County Department of Parks, Recreation and Cultural Resources, its agents, and employees, I, on behalf of myself, my executors, administrators, heirs, next of kin and successors, hereby covenant to hold harmless and indemnify Arlington County, Arlington Coed Kicks and the United State Specialty Sports Association (USSSA) and all of its officers, departments, agencies, agent, employees, and volunteers from any and all claims, losses, damages, injuries, fines, penalties, and costs (including court cost and attorney's fees) charges, liabilities or exposures, however caused, resulting from, arising out of, or in any connection to my or my family's participation in the above described program. I have read and understand this HOLD HARMLESS AGREEMENTS and by my signature agree to its terms.

Furthermore in consideration of being allowed to participate in any way in the “Arlington Coed Kicks” who is an affiliate of the UNITED STATES SPECIALTY SPORTS ASSOCIATION athletics/sports program, related events and activities, the undersigned acknowledges, appreciates, and agrees that:

The risk of injury and/or illness from the activities involved in the program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist;
The risk to have contact with individuals, who have been exposed to and/or have been diagnosed with one or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or maladies does exist, and it is impossible to eliminate the risk that I could be exposed to and/or become infected through contact with or close proximity with an individual with a communicable disease;
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume all full responsibility for my participation;
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT ON MY OWN BEHALF AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I understand that I am responsible for providing my own medical insurance and any other type of insurance I deem fit to cover any and all risks, including injuries that I may incur as a result of or in connection with my participation in ACK activities.

I am eighteen (18) and older and have read the foregoing provisions. I understand them and agree to be bound by them.

ACKNOWLEDGEMENT BY ADULT PARTICIPANT: By acknowledging and signing in the section below, I agree and verify the following: 1) I consent and agree to assume the risks of participation in these programs; and 2) that I specifically agree to the release as provided herein of all the Releasees, and, for myself, my heirs, assigns and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my involvement or participation in these programs EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I also acknowledge that I am aware of the League Rules and Regulations as posted to the ACK website http://www.leaguelineup.com/newsitem.asp?url=acksoccer&itemid=2076030 and will strive to abide by them.

Acknowledgement of ACK COVID-19 return to play guidelines. ACK COVID-19 Return to play Guidelines * *

By checking this box, I acknowledge that I have read and understand the ACK COVID-19 return to play guidelines.

I have read the above warning and completely understand its terms and I agree to abide by the rules, instructions and waivers of Arlington Coed Kicks. *

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Date Registered: * +