if yes Date of last seizure:
If yes, explain:
Special Dietary Needs
If yes, explain:
If yes, explain:
Is student currently taking medication
If yes, list medications needed for this activity:
Other information or direction from parent:
I consent to First Aid during practice/ competition:
Southern Connection Org (SCO) only collects personal information when you request our services and only uses the information collected to provide those services for you. If you choose to make a purchase, you will be asked to provide contact information (such as your name and address) and financial information (such as your credit card number and expiration date). This information is used for billing purposes and to process your order. SCO handles all of this data with the utmost confidentiality.
Any personal information provided will not be traded, rented, sold or otherwise shared with anyone outside of SCO, Big Peach Conference and AYF/AYC or used for reasons beyond those contemplated in this statement. From time to time, we may engage third parties to process your information on our behalf; however, none of affiliates (such as our credit card company) have permission to retain, share, store or use personal information for any reason other than providing the requested service.
Your payment and personal information is always safe. Our Secure Sockets Layer (SSL) software is the industry standard and among the best software available today for secure commerce transactions. It encrypts all of your personal information, including credit card number, name, and address, so that it cannot be read over the internet." (etc.)
Furthermore, your credit card number, expiration date and CSV code is never stored in our systems.
Our systems are routinely scanned by a third-party provider for security vulnerabilities in compliance with the policies of VISA / MASTERCARD.
TERMS AND CONDITIONS – Southern Connection Org
AGREEMENT BETWEEN USER AND Southern Connection Org
The network of Southern Connection Org operated by Southern Connection Org or its affiliates or subsidiaries, is comprised of various Web sites and Web pages. The Southern Connection Org websites are offered to you conditioned on your acceptance without modification of the terms, conditions, and notices contained herein. Your use of the Southern Connection Org Web Site constitutes your agreement to all such terms, conditions, and notices. Your use of a particular Southern Connection Org website included within the Southern Connection Org Web Sites network may also be subject to additional terms outlined elsewhere on that website (the "Additional Terms"). Additionally, the Southern Connection Org Web Site may themselves contain additional terms that govern particular features or offers (for example, sweepstakes or chat areas). In the event that any of the terms, conditions, and notices contained herein conflict with the Additional Terms or other terms and guidelines contained within any particular Southern Connection Org website, then these terms shall control.
USE OF SITE, PERSONAL AND NON-COMMERCIAL USE LIMITATION Unless otherwise specified; the SOUTHERN CONNECTON ORG Web Sites are for your personal and non-commercial use. You may not modify copy, distribute, transmit, display, perform, reproduce, publish, license, create derivative works from, transfer, or sell any information, software, products or services obtained from the SOUTHERN CONNECTON ORG Web Sites. You may display and, subject to any expressly stated restrictions or limitations relating to specific material, electronically copy, download and print hard copy portions of the material from the different areas of the Site solely for your own non-commercial use, or to place an order with SOUTHERN CONNECTON ORG or to purchase SOUTHERN CONNECTON ORG products. Any other use of materials on this Site, including but not limited to the modification, reproduction, distribution, republication, display or transmission of the content of this Site, without prior written permission of SOUTHERN CONNECTON ORG is strictly prohibited. Harassment in any manner or form on the Site or any of the SOUTHERN CONNECTON ORG Websites, including via e-mail and chat or by obscene or abusive language is strictly forbidden. Impersonation of others, including a SOUTHERN CONNECTON ORG employee, host, or representative or other members or visitors on the Site is prohibited. You may not upload to, distribute, or otherwise publish through the Site any content which is libelous, defamatory, obscene, threatening, invasive of privacy or publicity rights, abusive, illegal, or otherwise objectionable, or which may constitute or encourage a criminal offense, violate the rights of any party or otherwise give rise to liability or violate any law. You may not upload commercial content on the Site or use the Site to solicit others to join or become members of any other commercial online service or other organization.
The entire content included in this Site, including but not limited to text, design, graphics, interfaces, or code and the selection and arrangements thereof is copyrighted as a collective work under the United States and other copyright laws, and is the property of SOUTHERN CONNECTON ORG. The collective work includes works that are licensed to SOUTHERN CONNECTON ORG. Copyright 2000-Present. ALL RIGHTS RESERVED. All trademarks, service marks, and trade names (collectively the "Marks") are trademarks or registered trademarks of and are proprietary to SOUTHERN CONNECTON ORG, or other respective owners that have granted.
all us at 912-421-4900 and leave a message if you have any questions.
For Billing Inquires please mail to:101 Blue Moon Xing, Ste 3 Box 112, Pooler, Ga 31322 Email:firstname.lastname@example.org.
As the parent / legal guardian of , I hereby give my consent and approval for my child to participate as a team member of Southern Connection Org, Panthers, registered Tackle Football AAU Team. I understand that there are certain risks of injury inherent in practice and competitions, as well as in traveling and other related activities incidental to my child’s participation, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in tackle football, healthy and has no physical/ mental disabilities or infirmities that would restrict full participation, except as listed below:
In addition to giving my full consent for my child’s participation. I do hereby waive, release and hold harmless, Southern Connection Org, its officers, coaches, sponsors and representatives for any injury that may be suffered by my child while participating in tackle football and the activities incidental thereto, whether the result of negligence or any other cause.
I am aware, Southern Connection Org is not responsible for transportation of my child to and from practice and competitions. It is my responsibility as parent/ legal guardian to transport or arrange transportation and chaperone of my child to practice and competitions, regardless of location.
I hereby consent to Southern Connection Org will photograph my child for the intended purpose of identification. Southern Connection Org will only share my child’s photo with the league, to fulfill the requirement of participation in competition. As well as SCO website.
Southern Connection Org will not release, post or share my child’s photo without written consent.
I give consent / I do not give consent
Date of Birth:
Parent/ Legal Guardian Name (print):