Guam Football Association- National Team Player Profile

Guam National Team-Player Profile
Please fill in the form below.
Player Birth Year*
Player Last Name*
PLEASE TYPE IN CALL CAPS
Gender*
FemaleMale
Player Height - Ft*
Weight*
First Preferred Position*
Formation: 1-4-3-3
Second Preferred Position*
Formation: 1-4-3-3

Player Contact Information
Full Name*
PrefixFirst Name - ALL CAPS Middle Name - ALL CAPS Last Name - ALL CAPS
Date of Birth*
MonthDayYear
Date
Home Phone Number
Country CodeArea CodePhone Number
Mobile Number*
Country CodeArea CodePhone Number
E-mail*
example@example.com
Reconfirm E-mail*
Please make sure email is typed in correctly
Home Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Mailing Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Time Zone*
Closest International Airport Hub

School Information
ALL ATHLETES ATTENDING SCHOOL KINDLY FILL OUT THIS SECTION. IF THIS DOES NOT APPLY TO YOU ENTER "N/A" INTO "SCHOOL NAME"
School Name
School Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Principal Name
PrefixFirst NameLast Name
E-mail
example@example.com
Athletic Director Name
PrefixFirst NameLast Name
Phone Number
Country CodeArea CodePhone Number
E-mail
example@example.com
School Head Coach Name
PrefixFirst NameLast Name
Phone Number
Country CodeArea CodePhone Number
E-mail
example@example.com
Player Work Information
Work Place
Enter N/A if this does not apply.
Supervisor Name
PrefixFirst NameLast Name
Title
(Supervisor/Manager/General Manager etc...) Enter N/A if this does not apply.
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Country CodeArea CodePhone Number
E-mail
example@example.com
Club Information
Club Name
League Name
Division
Head Coach Name
PrefixFirst NameLast Name
Phone Number
Country CodeArea CodePhone Number
E-mail
example@example.com
Team Point of Contact Name (Team Manager)
PrefixFirst NameLast Name
Phone Number
Country CodeArea CodePhone Number
E-mail
example@example.com

Parent(s)/ Guardian(s) Contact Information
ALL ATHLETES 18 YRS AND BELOW MUST PROVIDE AT LEAST 1 (ONE) PARENT/GUARDIAN
Mother/ 1st Guardian Name
PrefixFirst NameLast Name
Home Phone Number
Country CodeArea CodePhone Number
Mobile Number
Country CodeArea CodePhone Number
Email
example@example.com
Reconfirm Email
Please make sure email is typed in correctly
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Father/ 2nd Guardian Name
PrefixFirst NameLast Name
Home Phone Number
Country CodeArea CodePhone Number
Mobile Number
Country CodeArea CodePhone Number
Email
example@example.com
Reconfirm Email
Please make sure email is typed in correctly
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code

Point of Contact
Designated contact person for all emails, whatsapp messages, etc... (Should this information change it is the responsibility of the player/parent to inform the GFA at: technical@theguamfa.com)
Phone Number (PLAYER)*
Country Code Area CodePhone Number
Email (PLAYER)*
example@example.com
Note
Parents: Input players phone number. Please indicate if player's does not have a phone. If player do not have phone number/email indicate "Does not have phone" If this does not apply to you kindly note - N/A
Phone Number 2
Country CodeArea CodePhone Number
Email 2
example@example.com
Relationship
Player - Player Name / Parent - Parent Name / Spouse - Spouse Name
Phone Number 3
Country CodeArea CodePhone Number
Email 3
example@example.com
Relationship
Player - Player Name / Parent - Parent Name / Spouse - Spouse Name
Note
Any additional notes for player's POC

Medical Information
Emergency Contact Name*
PrefixFirst NameLast Name
Relationship*
Mobile Number*
Country CodeArea CodePhone Number
Hospital/ Clinic Preference*
Physician Name
PrefixFirst NameLast Name
Pick One*
Self-PayInsuranceOther
Mobile Number
Country CodeArea CodePhone Number
Insurance Company
Policy Number
Allergies or Special Health Considerations*
Enter N/A if this does not apply

Waiver Form
RELEASE, ASSIGNMENT OF RIGHTS AND APPOINTMENT OF AUTHORITY FOR MEDICAL TREATMENT
In consideration of the permission granted to me, (continue below for player name)
Print Full Name
, to participate in Guam Football Association (GFA) activities as a member of the GFA National Team, by GFA, and/or any of its affiliate organizations, it’s clubs, coaches, players, agents, employees, representatives, officers, successors, sponsors and assigns, I, for Myself and my heirs, executors, administrators, or assigns, hereby forever irrevocably waive, release and discharge:
a)    GFA, its clubs, coaches, agents, employees, representatives, officers, National Team players, successors, sponsors and assigns, media contractors, and;
b)    Such competitor National Team, its clubs, coaches, players, agents, employees, representatives, officers, successors, sponsors and assigns, and media contractors (hereinafter collectively referred to as “competitor National Team”),
from any and all claims, demands, actions, judgements, and executions, which I, now have or may have, or ever had, or may accrue during my participation on the GFA National Team, whether known or unknown, suspected or unsuspected, hereby waiving any statutory provision which may preserve any rights to me as stated in Guam Code Annotated § 82602 or § 82604, whether caused by, arising out of, or in any manner connected to, my participation as a:
a)    GFA National Team player of GFA or;
b)    as a Player in any competition with, or;
c)    involving a competitor National Team,
with this release and waiver to be construed as broadly in scope and manner as law may allow, including, but not limited to, damages or injuries I may incur during my GFA National Team sponsored sports activities or related activities as heretofore set forth, further including any and all damages or claims for physical or emotional injury, injury to privacy, including photography of my activities while representing GFA as a National Team member whether still or motion, injury by disclosure of any matter within my Player Profile application or any competition statistics posted or used by GFA or by any media contractor in any media, website or promotional activity, of or competition statistics or any other claim of any kind or character or medical treatment authorized by my appointed representative.

EMERGENCY: In case of need for emergency medical treatment which I am unable to personally authorize, whether for lack of mental competency or physical injury, I hereby authorize and appoint as listed on Player Profile under Medical Information (page 9) to my attorney-in-fact to authorize such treatment beyond on field or transportation to a medical facility for which I authorize GFA, or such emergency medical personnel as may be in attendance of any competition, to render to me as may appear necessary for the preservation of life or incidental injury in competition, under supervision of the GFA Officers, representatives and coaches.

MEDIA/PHOTOS/LOGOS/BRANDING: Additionally, I grant and assign to GFA, its clubs, representatives, officials, coaches, agents, employees, officers, successors, sponsors media contractors, and such competitor National Teams, use of my Player Profile and statistical information for competition and promotional use as GFA deems beneficial or useful. I understand that any picture, image or other form of long term or permanent memorial of me which includes any image or information generated by GFA, is the sole property of GFA, whether copyrighted or patented or not, and I agree that I may not use such materials for any commercial purpose whatsoever without the express advance written authorization of the duly authorized representative of GFA. I understand that this limitation does not prevent me from limited duplication of such materials in representations of me for memorials distributed to my immediate family, those being my mother, father, sisters, brother, grandparent, spouse and/or child/children.
PLAYER Signature*
Clear
Parent/ Guardian Signature if under 18 years old.
First - PARENT/GUARDIAN Signature
Clear
Parent/ Guardian Signature if under 18 years old.
Second - PARENT/GUARDIAN Signature
Clear
Parent/ Guardian Signature if under 18 years old.
Date*
MonthDayYear
Date

COVID-19 WAIVER OF LIABILITY AND INDEMNIFICATION
NOTICE OF ENTRY UPON PREMISES AT OWN RISK, CONDITIONAL ENTRY SUBJECT TO IMMEDIATE TERMINATION AT ANY TIME
·         Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Guam Football Association (GFA) is taking extra precautions with the care of every athletes and personnel to include health status and enhanced sanitation/disinfection procedures in accordance with the Department of Public Health and Social Services, CDC, Guam’s Road to Recovery (Government of Guam) guidance. However, GFA understands that it cannot assure or represent that any precautionary conditions can assure your individual health. Therefore, you are specifically warned that your entry onto the premises of GFA is a voluntary act and that you do so under implied waiver of any and all liability of GFA, its officers, employees, attorneys, representatives, visitors, associates, or any other characterization of any other person or entity who or which may be upon the premises of GFA at the time of your entry onto the premises of GFA. To memorialize this waiver further, but not in any manner limiting this waiver, GFA provides the following notices and requires that this document be signed, however, the failure to sign this document, to read its content or any other defense to the enforcement of the waiver voluntarily entered into by your entry upon the premises, does not affect this waiver. YOU ENTER UPON THE PREMISES OF GUAM FOOTBALL ASSOCIATION AT YOUR OWN RISK AND ARE ADVISED TO TAKE SUCH PRECAUTIONS AS NECESSARY FOR YOUR SAFETY AS YOU DEEM APPROPRIATE AND AS PERMITTED BY GUAM FOOTBALL ASSOCIATION. GFA retains the legal right to expel anyone from its premises at any time as GFA may deem desirable, whether or not a truthful and executed waiver has been provided to secure conditional admission onto GFA premises.
Because GFA desires to protect entrants upon its premises, while denying any duty or legal obligation to do so, from any health exposure, GFA requires that you READ AND COMPLETE the disclosure and waiver below.
·         Any individual with respiratory symptoms should be considered a possible case of COVID-19. All customer/athletes and personnel must be made aware not to attend GFA events, meetings or training if they are unwell with any of the following symptoms, even if only mild:
·         Cough
·         Sore throat
·         Fatigue
·         Fever (e.g. night sweats or chills)
·         Difficulty Breathing/shortness of breath

I agree to the following:
I understand the above symptoms and affirm that I, as well as all household members with COVID-19, do not currently have, nor have experience the symptoms listed above WITHIN THE LAST 14 DAYS. *
Initials
I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS. *
Initials
I understand that GFA cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form. *
Initials
·         GFA is following these enhanced procedures to prevent the spread of COVID-19:
·         Develop, educate and communicate Social Distancing policies to minimize risk to any person at GFA and optimize the health of the athletes and personnel;
·         Display markings/signs to remind any person entering/accessing GFA;
·         Each person required to wear mask except upon entry into pitch/grid during training;
·         Each person required to wash hands upon arrival and before leaving;
·         Educate and train all necessary protocols to ensure safety and practice good hygiene;
·         Prepayment for services available if person prefer contactless checkout;
·         All surfaces will be wiped thoroughly with high grade disinfectant before and after each session/visit.
By signing below I acknowledge and represent that I have read the foregoing Waiver of Liability, understand it and sign it voluntarily as my own free act and deed, including without limitation the Release of Liability and Indemnification requirements contained in this document; I am sufficiently informed about the risks involved in using the GFA facilities to decide whether to sign this document; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this Wavier of Liability shall be governed by and construed in accordance with Guam law, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of the Wavier of Liability as a whole. This waiver remains in effect until the Governor of Guam lifts all COVID-19 related mandates.
By signing below, I agree to each statement above and release GFA from any and all liability for the unintentional exposure or harm due to COVID-19.
PLAYER Signature*
Clear
Parent/ Guardian Signature if under 18 years old.
First - PARENT/GUARDIAN Signature
Clear
Parent/ Guardian Signature if under 18 years old.
First - PARENT/GUARDIAN Signature
Clear
Parent/ Guardian Signature if under 18 years old.
Date*
MonthDayYear
Date
Should be Empty:

Guam National Team-Player Profile

Player Contact Information

School Information

Player Work Information

Club Information

Parent(s)/ Guardian(s) Contact Information

Point of Contact

Medical Information

Waiver Form

COVID-19 WAIVER OF LIABILITY AND INDEMNIFICATION