Clone of 901 Girls With Goals Mini Camp

901 Girls With Goal Keeper Clinic

The Kroc Center 800 East Parkway S Aug 15 9-11am
Clinic will start at 9am, please arrive no later than 8:55am, be dressed and ready to play. Open to girls in grades 6-12. Please expand and complete each section. Then, provide your e-signature and click Submit to reserve your spot. Spots are limited.
Player Information
Name

First NameLast Name
With which racial and ethnic group do you identify? (Mark all that apply.)
In order to continue our programs at 901 Girls With Girls we often seek charitable grants from foundations that require anonymized demographic information about the girls we serve.
How did you find out about us?
What school do you go to?
What grade are you in?
Did you play on a school or other team last school year?
How many years have you played soccer?
Does player have experience playing goalie?
Does player have goal keeper gloves? (This is not a requirement)
Adult T-shirt size
Any allergies or medical conditions?
Does player have any food or environmental allergies, Injuries, or Medical Conditions we need to be aware of? We want to ensure we keep them safe.
Parent/Guardian Infomation

Please provide information about yourself in case we need to contact you, In addition, we ask for additional information in case of emergency if we are unable to reach you and we need to contact another adult on behalf of, or in regards to your child.
Parent Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address (Optional)

Street Address

CityState / Province

Postal / Zip Code
Additional Adult Contact in case of emergency

First NameLast Name
Additional Adult Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
901 Girls With Goals and Play Where You Stay may take photographs and video of students/players and staff for the purposes of promoting girls soccer, 901 Girls With Goals, and Play Where You Stay and fundraising. The minor listed in this form may be included in such photos and videos. Because soccer is a team sport, it may not be feasible to delete the minor from such photos and videos. However, if requested below, 901 Girls With Goals will make reasonable attempts to delete the minor from such photos and videos before they are used.
Photo and Video Notice Selection
Recognizing the possibility of injury or illness, by including my player as a participant in this program, I consent to my player particpating in the 901 Girls with Goals/Play Where You Stay program. Further, I hereby release, discharge, hold harmless and will indemnify 901 Girls With Goals, Play Where You Stay, involved entities, sponsors, their employees, personnel, and volunteers, including the owners of the field and facilities utilized for the program, from any claim by or on behalf of my player as a result of my player's participation in the program and/or being transported to or from the programs.

I hereby authorize the transportion of my player to or from the program. I give my consent for a coach, program lead, emergency medical services, and/or licensed medical doctor, nurse, or dentist to provide my player/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.
Parent/Guardian Consent Selection
Signature
Should be Empty:

901 Girls With Goal Keeper Clinic

Player Information

Parent/Guardian Infomation