GLGK West Side Winter 1 Indoor Registration U9-U13
6:00p - 7:00p Nov 14th - Jan 30th(No session 11/28, 12/26) Force Sports Rocky River 21220 Center Ridge Rd, Rocky River, OH 44116
Player Name
*
First Name
Last Name
Player Age
*
Address
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Street Address
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Samoa
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Senegal
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eSwatini
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Tanzania
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Wallis and Futuna
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Email
*
Club Team
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*
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Youth Small
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Adult Small
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Referred By
Emergency Contact
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Emergency Contact Phone Number
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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.
*
I have read, understand and agree to the waiver
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Great Lakes Goalkeeping West Side Indoor
$
350.00
First Five Weeks
$
200.00
Second Five Weeks
$
200.00
Total
$
0.00
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