Coach-Mentor Training Resource Hub Registration

   

Coach-Mentor Information

First Name

Last Name

Email

Date of Birth

Ethnicity

Please select... African-American and Black American-Indian/Native Alaskan Asian Caucasian Haitian Latino/Latina/Latinx and Hispanic Pacific Islander Other/Multi-Ethnic Prefer not to answer

Gender

Please select... Female Male Gender non-binary Prefer not to answer

Number of Years Coaching

Please select... I am new to coaching/mentoring 1-5 years 6-10 years 11-15 years More than 15 years

Primary Sport Coached

Please select... Basketball Football (American) Golf Lacrosse Soccer Softball or Baseball Track & Field Volleyball Other

Primary Sport Coached - Other

Primary Affiliation

Please select... Sport Club or League Out-of-School Youth Organization K-12 School College or University Other

Primary Affiliation - Other

Name of Organization

I am a Program Administrator at my organization

How did you hear about us?

Please select... Presentation/Conference/Meeting National/State Partner NCYS Soccer for Success Foundation Newsletter/Email Sport Club Afterschool Program Social Media Web Search Other

Select which social media

Please select... U.S. Soccer Foundation Twitter/Instagram Other Twitter/Instagram Other Social Media

If other, please describe

Are you attending an in person CMT? (Please only answer yes if you have received invite to attend CMT in your community)

YesNo

Please write the corresponding code for the CMT you are attending

Employee/Volunteer Background Checks - By checking the box below, I affirm that my youth organization has a criminal history background check process in place for its employees, and that all employees or volunteers must be cleared through that process prior to beginning work for the organization.

I agree

Indemnification - By checking the box below, I agree to indemnify, defend and hold harmless the U.S. Soccer Foundation from and against any and all third party claims, demands, losses, damages, liabilities, costs and expenses (including reasonable legal/attorneys' fees and expenses arising out of or related to any legal proceeding and any legal appeal) ("Claim" or "Claims") related to the program and liabilities of any kind or nature whatsoever, whether in contract, tort, or otherwise, resulting from any claim (including, without limitation, personal injury, bodily injury, sickness or disease, death, or property damage) actually or allegedly arising out of or in connection with operation, location, or condition of the program, my failure to comply with any applicable state or local laws, or any person's participation in the program, whether authorized or unauthorized, proper or improper.

I agree

Medical Release/Waiver/Indemnity Agreement & Model Release and Authorization to Video/Photograph - By checking the box below, I understand that participation in a U.S. Soccer Foundation Coach-Mentor Training event ("Event") involves certain inherent risks of injury, despite all safety precautions taken by the U.S. Soccer Foundation and its operators. Therefore, I will assume all risks, injury, sickness or illness, including communicable diseases, that may occur during the participation in any activities or use of facilities associated with the Event. In the event that I need medical treatment due to accident or injury or natural causes while participating in the Event. I authorize the local staff/operators to take whatever action is necessary to care for me. I hereby give permission for the local staff and operators to use their best judgment in arranging for my emergency medical treatment. By checking this box below, I acknowledge that I am aware of the potential risks of participation in any activities or use of facilities associated with the Event, and in no way hold the U.S. Soccer Foundation, its respective parent, its subsidiaries or affiliates, or their respective management, agents, employees, directors, officers, sponsoring agencies, partners, volunteers or the facility or its operators, coaches, officials, or advertisers, (Individually and Collectively, the "Released Parties"), liable for any injury that I may sustain. I, FOR MYSELF, DO RELEASE, ABSOLVE, INDEMNIFY, AND HOLD THE RELEASED PARTIES HARMLESS AGAINST ANY CLAIMS OF INJURY OR DEATH IN CONNECTION WITH ANY AND ALL OF THE ACTIVITIES MENTIONED. Finally, by checking the box below, I hereby grant a license to the U.S. Soccer Foundation and Released Parties, including any advertising agencies, to use and to license others to use my name, recorded voice, image, picture or likeness in any live or recorded audio, video or photographic display or other transmission for purposes of promotion and publicity in connection with the Event any any future U.S Soccer Foundation events or programs and hereby waive any rights of compensation or ownership thereto. I HAVE READ, AND I UNDERSTAND, AND I VOLUNTARILY SIGN THIS MEDICAL RELEASE WAIVER/INDEMNITY AGREEMENT AND MODEL RELEASE AND AUTHORIZATION VIDEO/PHOTOGRAPH.

I agree