Fairmont (Trinity) Dynamics and GK Dynamics 2018/19

Location: Trinity Assembly of God

Fairmont, WV

(70 Maranatha Dr. White Hall WV 26554)

Private lessons Ages 2010-2000

Age Matrix: Based on birth year
2010-u9
09-u10
08-u11
07-u12
06-u13
05-u14
04-u15
03-u16
02-u17
01-u18
00-u19

Programs start the WEEK OF please check which DAY you would like!
1st Program: Week of November 26th, Dec. 3rd, 10th and 17th
2nd Program: Week of January 7th, 14th, 21st and 28th
3rd Program: Week of February 4th, 11th, 18th and 25th
Make up week of March 4th

Fairmont
Location: Trinity Assembly of God in Fairmont
(70 Maranatha Dr. White Hall WV 26554)

Mondays Boys Dynamics
4pm Ages 2005-2000 u14-u19
5pm Ages 2010-2009 u9-u10
6pm Ages 2008-2006 u11-u13
7pm Ages 2008-2006 u11-u13
8pm Ages 2005-2000 Yrs Premier Class(must have dynamic experience or travel soccer experience)

Fridays Girls Dynamics
4pm Ages 2005-2000 u14-u19
5pm Ages 2010-2009 u9-u10
6pm Ages 2008-2006 u11-u13
7pm Ages 2008-2006 u11-u13
8pm Ages 2005-2000 Yrs Premier Class(must have dynamic experience or travel soccer experience)

Dynamics Class ( 8-10 players per class)

Premier Dynamics Class (4-8 players per class with a higher level of expectation and difficulty)

Premier Cost: $70 per program

Dynamics Cost: $50 per program

**If registering for a class that is full you will be placed on a waiting list.

Child's Name *

First Name Last Name

Date Of Birth *

- Month - Day Year

Dynamics *

1st Program 2nd Program 3rd Program ALL Three

First Program Time Slots

Second Program Time Slots

Third Program Time Slots

E-mail *

Parents Name *

First Name Last Name

Phone Number *

- Area Code Phone Number

Medical Release Terms conditions and Agreement *

Team Waiver & Liability Agreement - I understand that there are risks associated with playing all sports and field related activities. In consideration for the privilege to use the facility and/or attend the camp/clinic, my signature indicates that I assume the risk of any injuries that myself or my children/wards/players may sustain while participating in any activity sponsored or approved by Valley Soccer Academy and Trinity Assembly of God for any injuries which myself or my children/wards/players may sustain while on the premises of Trinity Assembly of God or facility utilized by Valley Soccer Academy and go, remise, release and forever hold harmless Valley Soccer academy LLC and their officers, agents, employees, coaches, independent contractors and/or team managers from any actions, suits, damages, claims, or judgments, that may result from any personal injury that myself and/or my children/wards/players may sustain while on the premises of the said facility, or while using the equipment of Valley Soccer academy, or while engaged in any activities sponsored by Valley Soccer Academy LLC. I also understand that Valley Soccer Academy is held harmless and will not issue credit in the event that I or my child/players, the attendees, cannot attend due to illness, injury, hazardous road conditions, severe storm, flooding, wind, war or other acts of God or any unforeseen occurrences that could frustrate the whole or any part of this event and/or schedule. I agree to allow photographs taken of myself and/or my children/wards/players to be used in any marketing/advertising publications by and for Valley Soccer Academy. I understand that Valley Soccer Academy and or Trinity Assembly of God does not provide health and/or accident insurance. I assume full and complete responsibility for any and all medical and/or dental bills arising out of my or my child’s/players’ participation in the Valley Soccer Academy sponsored activity, and hereby agree to indemnify and hold harmless Valley Soccer Academy LLC and its parties from any and all liability associated with my or my child’s/players’ participation in clinics/camps. I insure that I am or my child/players are physically and mentally able to participate in physical activities and have been examined by a licensed medical physician within one (1) year prior to attending this clinic/camp. I give permission for Valley Soccer Academy LLC and its associates or contracted health care provide to start preliminary treatment and arrange transportation for me or my child to a local Emergency Room in the event that I or my child/players become(s) ill or injured. By signing this Waiver and Liability Agreement, I acknowledge that I HAVE READ AND FULLY UNDERSTAND AND AGREE TO ALL OF ITS TERMS AND CONDITIONS INCLUDING PERMISSION TO TREAT AGREEMENT. I further state that I have executed this waiver and liability voluntarily and with full knowledge of its significance to be binding on my, my heirs, executors, administrators and assigns.

Payment Procedure

1. Please select all the programs you want to pay for below.

2. Please double check to make sure you signed up for the correct program and time slot before payment.

Programs *

Registration Fee (Required) $ 2.00

Dynamics One Program $ 50.00

Dynamics Two Programs $ 100.00

Dynamics Three Programs $ 150.00

Premier Class One Program $ 70.00

Premier Class Two Programs $ 140.00

Premier Class Three Programs $ 210.00

Total $ 0.00

DYNAMICS - Is a professionally based program which concentrates on improving your technical skills/dribbling and control of ball, shooting/striker skills, change of speed and direction/agility, alongside our popular 3v3 Futsal SOCCER!!!

Winter Dynamics Registration Form

Please select which program(s) your child will be attending. Please select a day and appropriate age/time slot.