Soccer Autopay

Thank you for your interest in our Ararat Soccer program. Our mission is to cultivate a nurturing environment where young players are empowered to achieve their utmost potential, fostering values of sportsmanship, character, fun, and holistic growth both on and off the field.

Please complete the form below to enroll in our soccer program’s monthly payment plan priced at $60 per month.

Child Full Name(Required)

First Last

Parent Full Name(Required)

First Last

Email(Required)

Phone(Required)

Date of Birth(Required)

Soccer Experience(Required)

Are you a Homenetmen Ararat member?(Required)

Yes

Agree to the RELEASE AND WAIVER OF LIABILITY below(Required)

I Agree

How did you hear about the soccer program?(Required)

T-Shirt Size(Required)

RELEASE AND WAIVER OF LIABILITY

To the fullest extent permitted by law, I hereby acknowledge and agree to the following:

Homenetmen Glendale “Ararat” Chapter, its related entities, and their respective members, managers, employees,
volunteers, and agents (“Ararat”) will not be liable for any injury to my person or property, or to the person or
property of any minor. On behalf of myself, my heirs (including any minors), personal representatives and assigns, I
hereby release, discharge and hold harmless Ararat from any and all liability and claims arising from my use, or any
minor’s use, of the premises wherein any program shall conduct its activity(“Facilities”), including, but not limited
to, all liability and claims arising from personal injury (including death), accidents or illness, and damage to, loss of,
or theft of property, whether caused by the active or passive negligence of Ararat, and I covenant not to sue Ararat
with respect to, and I waive any and all claims that I may have now or in the future against Ararat for any liability
arising from my use, or any minor’s use, of the facilities. I (each member, guest, or participant, whether an adult or
minor) agree that if I engage in any physical exercise or activity at any facility, I do so entirely at my own risk. This
includes, without limitation, use of the gymnasiums, parking area, sidewalk area, or any equipment in the facilities
and assume all risks of injury, illness, damage or loss or theft of any personal property. I also agree to abide by all of
Ararat’s rules and regulations.

I agree to voluntarily give up any right that I may otherwise have to bring a legal action against
Ararat for negligence, or any other personal injury, property damage, or loss action.

I have read and understood all of the above, and the information I have provided is correct to the best of my knowledge.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address City State ZIP Code

Subscription

Price:

Upon registration, all details will be emailed to you. Feel free to reach out to Nar@ararat.org with any questions. Ararat membership is required to be part of our soccer program. If you are not a member, click here to complete the online membership form.