BLGK Academy Registration Form

BLGK Academy - Registration Form

Old Liverpool Road Training Center - Syracuse, NY

www.BLGK.net
Athlete Information
Athlete Name*

First NameLast Name
Athlete Birthdate

MonthDayYear
Date
Athlete Phone

Area CodePhone Number
Athlete E-mail*
Parents/Guardian Name*

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent Phone

Area CodePhone Number
Parent Phone

Area CodePhone Number
Parent Email
example@example.com
Alternate Parent Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you ever had goalkeeper specific training?

YesNo
If you answered yes, please provide details
Shirt Size
Location interested in training at

SyracuseUtica (by appointment only)
Important Notes
- You will be provided a BLGK training shirt that is to be worn at training.
- Please bring water, there is a fountain in the facility if you should need more.
- Plan to arrive early to stretch what you need and be prepared to begin training promptly.
- Please check our Facebook and Instagram, as well as the emails listed, for updates regularly.
- TeamSnap is our communication medium, please download and turn on notifications for the app.
- Fees: $325 - Field Rental (Due first week of each session block) $30 - Training (Weekly)
  - Cash, Check (payable to BLGK Academy) , or Venmo (@mattmilograno) accepted
  - Please inquire about training block payment in full if you are interested
- Those interested in training in Utica - please reach out to Coach Matt to set up times for small group and individual sessions
Club Team & High School Team Information
Do you currently play on a club? (If no, skip to high school information section)

YesNo
Club Team
Club Coach Name*

First NameLast Name
Club Coach Number

Area CodePhone Number
Club Coach Email*
example@example.com
High School*
High School Coach Name*

First NameLast Name
High School Coach Email*
example@example.com
High School Coach Number

Area CodePhone Number
School Graduation Year*
NCAA, NJCAA or NAIA division desired to play at:

NCAA Division 1NCAA Division 2NCAA Division 3NJCAA (Junior College)NAIA
Major interest in college (Undecided is acceptable)
Colleges of interest
Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Release of Liability

Although the safety of all sports activities is the primary concern, indoor sports activities at Old Liverpool Road Indoor Training Center's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Old Liverpool Road Indoor Training Center, BLGK Academy, and the persons in charge.
I have read and agree to the above conditions*

YesNo
Confirmation E-mail*
Signature*

Clear
After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact BLGK at mattmilograno@gmail.com.
Should be Empty:

Release of Liability