GLGK East Side Winter 1 Indoor Registration U13-U18
8:00p - 9:00p November 4th-January 27th Force Sports Northfield 4505 Northfield Rd, Warrensville Heights, OH 44128
Player Name
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First Name
Last Name
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Address
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Street Address
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Email
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example@example.com
Club Team
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School Team
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Youth Small
Youth Medium
Youth Large
Youth XL
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Adult XL
Referred By
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Emergency Contact Phone Number
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My Products
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Winter 1 East Side Goalkeeping
$
350.00
First Five Weeks
$
200.00
Second Five Weeks
$
200.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Release I verify that my child has been checked recently by a physician and is physically able to participate in soccer activities. Also, as a parent/guardian, I authorize any first aid or emergency care that may become necessary for my child while he/she is participating. Further, I understand that there is an inherent risk of injury in playing soccer. Consequently, I hereby release and hold harmless, Great Lakes Goalkeeping Academy, Jason Kubbins, Andy Hogarth, their staff and from liability should any injury, loss of life, or loss/damage to equipment that may occur during the camp. By executing this document, I hereby assume all risk of injury or lost or damaged property. In case of emergency, this form and signature will serve as authorization for a hospital to administer medical treatment. All pictures, videos, and contact information collected by Great Lakes Goalkeeping Academy may be used at the discretion of Jason Kubbins for promotional use.
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