Registration Form

Registration Form

Gallant Goalkeeping
Goalkeeper Info*

First NameLast Name
Date of Birth (MM/DD/YYYY)Gender
Goalkeeper Phone Number (If Applicable)
Please enter a valid phone number.
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Phone Number*
Please enter a valid phone number.
What days of the week work best for you?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What time of day works best for you on these days?*
What city are you located in? What city works best for training?*
What type of training do you prefer?*
If Group Session, is there other specific keepers you would like to train with? Leave blank if N/A
What specific areas are you looking to improve and what are your goals and aspirations as a goalkeeper?*
Are you ok with me taking pictures and videos of training sessions to post online to social media and my website?*

YesNo
Injury Waiver

By signing below, I acknowledge that my child or myself (If over 18 years of age) is voluntarily participating in this activity and understand that there are inherent risks of physical injury in the game of soccer, including but not limited to sprains, strains, and fractures. I hereby assume all such risks and release Gallant Goalkeeping from any liability for any injuries sustained during participation.
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Injury Waiver