ATFA Soccer Club Application Form

Soccer Club Application
Player Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Are there any allergies?
Are there any

Program Info

Our football course aims to provide not only football education for our players but also to support their relationships with school, club, family, social environment, and personal development. The course will primarily be opened for the age group of 3 years. If the number of participants does not exceed 10, classes of similar ages can be combined.

Futbol kursumuz oyuncularımızın futbol eğitiminin yanı sıra okul, kulüp , aile , sosyal çevre ile ilişkilerinin ve kişisel gelişiminin sağlanmasını amaçlamaktadır. öncelikli olarak kursumuz 3 yaş grubunda açılacaktır . 10 kişiyi geçmediği takdirde yakın yaştaki sınıflar birleştirilebilir.

CLASS	DAY	TIME	BEGIN	END	LOCATION
KG-1	MONDAY	4:30- 5:30	MAY 1	JUNE 5	PINNACLE GYM - LAWRANCE FIELD
2-3	THURSDAY	4:30- 5:30	MAY 4	JUNE 8	PINNACLE GYM - LAWRANCE FIELD
4-5	SATURDAY	3:30 - 4:30	MAY 6	JUNE 10	PINNACLE GYM - LAWRANCE FIELD
MIDDLE SCHOOL	SUNDAY	9:00 - 10:00	MAY 7	JUNE 11	LONG PARK /CATHARPIN PARK

Parental/Guardian Information
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to Player
Physician's

First NameLast Name
Phone Number
Medical/Hospital Insurance Company
Medical/Hospital Insurance Company
Policy Number

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, ATFA Soccer Club, their sponsors, the ATFA and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in ATFA programs and/or being transported to or from the same, which transportation I hereby authorize.*

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Please choose the right age group for your child.
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KG - 1$90.00

GRADES 2 - 3$90.00

GRADES 4 - 5$90.00

MIDDLE SCHOOL$90.00

Subtotal $0.00Tax $0.00Total $0.00

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Soccer Club Application

Program Info

Parental/Guardian Information