THIRD Annual
Jay O'Connor Memorial
3v3 Mini World Cup Indoor Tournament

Team Registration Form

Team Managers: Please complete this application and mail it to the address at the bottom of the form. Each of your players must also print out a waiver form and send it to the address on the form or bring it to the first match night. You may also use register your team online. Please note price listed below is per player ($195 per team). We will confirm your participation in the tournament via email prior to the first match night.

The Sessions Listed Below are Currently Available for Registration
Session	Type	Location	Dates	Times	Cost

Please note: We will make every effort to accommodate your requested tournament, but we may combine age groups and/or move tournament dates to create developmentally appropriate competition. For more information, please contact us at 3v3@teamcos.net or (703) 437-8135.

Location: Match days will take place at Worldgate Sport and Health Club (Herndon, VA). Space is limited to 48 teams and applications will be accepted on a “first come, first serve” basis.

Check-in is required at the tournament desk 20 minutes prior to your team's first game on each match day.

Equipment: All participants must wear appropriate soccer attire, including indoor soccer or tennis shoes and shin guards. Team COS will provide pinnies although teams are encouraged to wear uniforms.

Reserve your spot by completing this form and submitting $195 payment. Refund Policy: The fee will be refunded only upon written request and if cancellation is made at least two weeks prior to the first day of the tournament, minus a $20 administrative fee.

Reminder: Tournament participants are guests of Worldgate Sport & Health Club and must behave appropriately at all times. Team managers are responsible for all team members. There is no ball-bouncing permitted in the hallways and all trash must be placed in the proper receptacles.

Soccer Club Affiliation (MYS, VYS, ASA, etc.)
Team Name (this is a mini world cup so please pick a country)
League/Division
Player 1 Name/Date of Birth/Home Phone/home address/parent(s) names/email adddress
Player 2 Name/Date of Birth/Home Phone/home address/parent(s) names/email adddress
Player 3 Name/Date of Birth/Home Phone/home address/parent(s) names/email adddress
Player 4 Name/Date of Birth/Home Phone/home address/parent(s) names/email adddress
Player 5 Name/Date of Birth/Home Phone/home address/parent(s) names/email adddress

Manager Info
First Name / Last Name
Home Phone (including area code)
Work Phone
Cell Phone
E-mail Address (Mandatory for Confirmation)
Asst. Manager/Coach Info (not required)
First Name / Last Name
Home Phone (including area code)
Work Phone
E-mail Address

How did you hear about the 3v3 tournament?
T-shirt Sizes for players	Child: Sm. Med. Lg. XL Adult: Sm. Med. Lg. XL

Do any of the players have any Medical Conditions We Should Be Aware Of? If so, please list here by player

If Paying By Credit Card: Please Circle Card Type: Visa MasterCard

Amt. To Be Charged: $________________ 16-Digit Acct. #: ________________________________

3-digit security code on back of card (after 16 digits): ____________ Exp. Date (mm/yy): _________

Please Print Name Of Cardholder: ____________________________________________________

Signature (Required for credit card): ________________________________________________

Please note a $4.00 processing fee will be added to all credit card payments.

Please mail payment and form to (please make payable to Jay O'Connor Scholarship Fund):

COS 3v3 Tournament
5717 Waters Edge Landing Ct
Burke, VA 22015

CONSENT, RELEASE AND AUTHORIZATION

I am the parent or guardian of the above named child (the “player”). I consent to the participation of the player in soccer-related programs operated by Curt Onalfo Soccer, Inc., including but not limited to training sessions, practices, games, and tournaments. I understand that the such programs are hazardous by their nature, and I assume all risk of injury or death arising from such activity, and accordingly I release, indemnify and agree to hold harmless Curt Onalfo Soccer, Inc., The Northern Virginia Community Foundation, and the owner and operator in which the applicable program is located, and their respective directors, officers, employees, sponsors, counselors, and staff from any claim, suit, demand, or action arising in connection with the player’s participation in programs operated by Curt Onalfo Soccer, Inc. I further assume all responsibility for all transportation to and from such programs. If the player requires medical attention in the judgment of the supervisor of any program in which the player is participating, and the player’s parent or guardian or emergency contact cannot be reached after reasonable efforts to contact them (it being understood that no such efforts are required in case of emergency) the undersigned hereby authorizes such supervisor or a representative of Curt Onalfo Soccer, Inc., to obtain and authorize medical treatment for the player.
I HAVE CAREFULLY READ THE ABOVE CONSENT, RELEASE AND AUTHORIZATION AND FULLY UNDERSTAND ITS CONTENTS. I UNDERSTAND THIS IS A RELEASE OF LIABILITY AND I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY.

Signature: _______________________________________________________________________
Relationship: __________________________________ Date: ______________________________