February Clinic MM February 2021 Clinic Registration Player Name* First Last Player Birth Date* Date Format: MM slash DD slash YYYY Player Grade*2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradePlayer Cell Phone*Home Phone*Player Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Player Email* Parent Name* First Last Parent Cell Phone*Parent Email 1* Parent other email Middlesex Magic February Clinic (2nd-5th grade) Price: $144.00 Middlesex Magic February Clinic (6th-8th grade) Price: $159.00 Middlesex Magic February Clinic (9th-12th grade) Price: $175.00 Discount CodeDiscount AppliedTEAM PAID BY SINGLE CHECKTotal $0.00 WaiversBy agreeing below, I acknowledge that I have read and understand this form and further understand the terms herein are contractual and not a mere recital.Acknowledgement*In consideration of participating in this tryout, practice, game, skill session, clinic, tournament and or league the player named above and the parent or guardian do hereby agree for ourselves, our heirs, executors and administrators, to release, hold harmless and forever discharge the hosting organization and their officers, staff, administrators, volunteers, sponsors and representatives and assigns, for and against any and all claims, actions, cause of actions, suits, judgments, and demands whatsoever directly or indirectly in connection the player’s participation in the event. I agree Medical Waiver*I/we being the legal guardians of the applicant authorize the staff of this clinic and its agents permission to request treatment to ensure the well being of our dependant. I certify that he is in good health and able to participate in the scheduled games. I agree COVID-19 Waiver Release of Liability*Waiver, Consent, Release of Liability COVID-19. The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. Middlesex Magic has put in place preventative measures to reduce the spread of COVID-19; however, Middlesex Magic cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Middlesex Magic programs or events could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Middlesex Magic programs or events and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Middlesex Magic programs or events may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Middlesex Magic employees, volunteers, and program participants and their families. Further, I attest that my child(ren) are healthy now and will be monitored by me, a parent, or a guardian before attending all Middlesex Magic programs or events each day and I will hold him out if any such symptoms arise. A health monitorization or check ensures and confirms that your child(ren) has not had these symptoms for 48 hour prior to each Middlesex Magic program or event; fever, abnormal cough of any kind, shortness of breath, body aches, sore throat, or loss of taste and smell. I attest that my child(ren) has not knowingly been in close contact with anyone who is known to have or be symptomatic of the Covid-19 virus and has not traveled outside the US or been in contact with anyone who has traveled outside the US in the last 14 days I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any Middlesex Magic program or events that Middlesex Magic or participation Middlesex Magic programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Middlesex Magic, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Middlesex Magic, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Middlesex Magic program. I HAVE READ THIS WAIVER AND RELEASE. I UNDERSTAND IT AND I AM SIGNING IT VOLUNTARILY. I certify that as parent/guardian of the athlete, I consent to his/her agreement to be bound by each of the terms and conditions in this waiver and release. I agree to the policy.