MENU
MENU
Giving
Why Support CCCBSD
Annual Fund
Annual Report
Ways to Give
Foundation, Corporate and Community Sponsors
Donor Privacy Policy
News & Events
News
Events
2024 Annual Spring Soiree
Lone Gull 10K Road Race
Community Programs
ASL Classes
Parent Infant Classes (PIP)
Hand In Hand Program
Distinguished Speakers
Community Sports Programs
Giving Tuesday 2024
Contact
MENU
MENU
About CCCBSD
Admissions
Virtual Tours
Alumni
History
Mission Statement and Vision
Family Resources
Meet Our Team
Executive Director
Our Campus
Careers
School Apparel
Faculty Portal
How are students placed in approved special education schools
Strategic Plan
The Children’s Center for Communication
CCC Academic Program
Support Services
How CCC Makes a Difference
Resources
Beverly School for the Deaf
BSD Academic Program
Support Services
How BSD Makes a Difference
Resources
Parent-Infant/Toddler Programs
About PIP
Parent Infant Classes (PIP)
Hand in Hand Series
Resources
Schedule a Visit
Outreach Services
About CCCBSD
▼
Admissions
Virtual Tours
Alumni
History
Mission Statement and Vision
Family Resources
Meet Our Team
▼
Beverly School for the Deaf
Board of Trustees
The Children’s Center for Communication
Executive Director
Our Campus
Careers
School Apparel
Faculty Portal
Strategic Plan
Giving
▼
Annual Fund
Annual Report
Foundation, Corporate and Community Sponsors
Donor Privacy Policy
Ways to Give
Why Support CCCBSD
News & Events
▼
News
Events
2024 Annual Spring Soiree
Lone Gull 10K Road Race
Community Programs
▼
ASL Classes
Parent Infant Classes (PIP)
Hand In Hand Program
Distinguished Speakers
Community Sports Programs
Giving Tuesday 2024
The Children’s Center for Communication
▼
CCC Academic Program
How CCC Makes a Difference
Resources
Support Services
Beverly School for the Deaf
▼
BSD Academic Program
How BSD Makes a Difference
Resources
Support Services
Parent-Infant/Toddler Programs
▼
About PIP
Resources
Schedule a Visit
Parent Infant Classes (PIP)
Outreach Services
Contact
Virtual Tours
How can we help?
Donate
Events
2024 Winter Soccer Volunteer Registration & Release Form
2024 Soccer Volunteer Registration & Release Form
Email
*
First and Last Name:
*
Parent/Guardian name (IF UNDER 18)
*
Address
*
Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Age
*
Date of Birth
*
Example: January 7, 2019
Home/Cell phone
Home
Cell
Parent/Guardian Phone Number (Home) (IF UNDER 18)
*
Parent/Guardian Phone Number (Cell) (IF UNDER 18)
*
Parent/Guardian email address (IF UNDER 18)
*
What dates will the volunteer participate in Soccer? Select as many as apply.
*
January 11
January 18
January 25
February 1
Check all that apply
Preferred Communication
*
Publicity Release 2024 Soccer Player/Volunteer Registration & Release Form
The Children's Center for Communication/Beverly School for the Deaf is a program that takes pride in using technological advances for educational purposes. These endeavors are often used to honor and promote the positive activities that occur on a daily basis. As part of standard practice, CCCBSD will use your child's image for internal media on a regular basis. CCCBSD defines internal media as photos/videos that can be viewed but are never shared externally as a hard copy or electronically (for example: photos in the classroom, classroom videos for shared experiences, photos/videos shown for events or presentations, etc.). Photos and videos are also used for purposes that require external media. CCCBSD defines external media as photos/videos that can be viewed and/or shared as a hard copy or electronically (e.g. Newspaper, annual reports, home notes, classroom photos emailed to families, YouTube, Facebook, etc.) CCCBSD will never post names of students to social media and websites. Only first names are given to newspapers. Parents will be notified if their child's likeness has been photographed for a newspaper article. If you have objections to your child being photographed or videoed for the purpose of external media please specify your objections below. (for example: All photos are fine. No video or All forms of media are okay but do not identify my child by name.)
Do you have any exceptions you would like to specify for external media?
YES
NO
Release Form
I give my child permission to take part in the basketball program at CCCBSD. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for disability, personal injury, or property damage for THE FOLLOWING ENTITIES OR PERSONS: The Children’s Center for Communication/ Beverly School for the Deaf and /or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that The Children’s Center for Communication/ Beverly School for the Deaf and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I hereby consent to medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. THIS WAIVER WILL BE EFFECTIVE FROM THE SIGNED DATE BELOW AND MOVING FORWARD.
Release Form Agree
*
I assume all risks and hazards incidental to such participation in CCCBSD games and activities. I/we agree to be present at all games and activities so that I/we can manage our child's specific needs. I agree to be solely responsible for my child
External Media Exceptions
Please describe your external media exceptions here (i.e. all photos are fine, but no video, OR all forms of media are okay, but do not identify my child by name.)
What external media exceptions should we be aware of?
Emergency Contact Information
Please fill out the following few questions to identify an emergency contact.
Contact's name
Contact's Phone Number
Contact's Relationship to Family
Electronic Signature or check box
CCCBSD does not take responsibility for images taken of your child by non CCC BSD staff members that may be published as external media (e.g. a photo video with your child's image in the background at school-wide events.). Further, I release CCCBSD, its Board of Trustees, employees, and other representatives from any known liabilities, known or unknown, arising out of the use of these materials.
I have read and fully understand all the above and hereby give my permission on all points from March 2, 2024 forward. While this permission form will be updated annually, it is understood that once external media is published it is impossible to guarantee that the material can be relinquished 100%.
*
I agree
Signature/Parent/Guardian Electronic Signature (IF UNDER 18)
signature
keyboard
Clear
Date
*
Name
Name
First
First
Last
Last
Submit
If you are human, leave this field blank.