Summer Program Registration Form

Summer Program Registration Form

Youth Transfer Skills
Participant Information
Participant's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please select which program you are registering for.

Other
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby grant my consent for my child to participate in all activities organized by the Maine Youth Empowerment Services(MEYES). In return for my child's inclusion in the Summer Soccer Program, I acknowledge and accept all potential risks and dangers associated with the activities. I release, discharge, and indemnify the Wrestling Program, as well as its coaches, instructors, and representatives, from any liability for any injuries sustained by my child during the course of travel to, involvement in, or return from any course-related events.

Grant permission to MEYES to take and use: video, photographs, and/or digital images of me, my
child/children for use in news releases, promotional projects and/or educational materials.

If my child is injured during these activities, I relinquish any and all claims against the Summer Soccer Program, including its coaches and associates, fellow participants, sponsoring organizations, advertisers, and, if relevant, the owners and landlords of venues where the events take place. It is understood that there is an inherent risk of injury in all sports, including soccer.
Signature
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