Clone of Shinnston Jr Futsal

Junior FUTSAL will emphasize the use of the sole of your foot, alongside small sided games and a Futsal game of 5v5, all under Futsal National Rules. Futsal is also played with a smaller, harder, low-bounce ball. The surface, ball, and rules together favour ball control and passing in small spaces. The game's "emphasis is on improvisation, creativity and technique.
Junior Futsal Registration Form

Please fill in the form below for a 1 Hour Futsal Class.
Age Matrix: Based on birth year, 5-9 year olds

2013-u6

2012-u7

2011-u8

2010-u9

2009-u10

Programs start the WEEK OF please check which DAY you would like!

Saturdays
1st Program: January 12,19,26 February 2nd.
2nd Program: February 16,23 and March 2,9.
Time: 2:30-3:30

age groups: 2012-2010 (U7-u8-u9) Boys and Girls

Cost: $35/program

Shinnston
Location: The Lighthouse at First Baptist Church of Shinnston

(72 Rebecca Street, Shinnston, WV 26431)
Child's Name *

First Name Last Name
Date Of Birth *

- Month - Day Year
E-mail *
Parents Name *

First Name Last Name
Phone Number *

- Area Code Phone Number
Please select which program(s) your child will be attending
Jr. Futsal *

1st Program 2nd Program BOTH Programs
Please select an appropriate age/time slot.
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 The Lighthouse at First Baptist Church of Shinnston for any injuries which myself or my children/wards/players may sustain while on the premises of The Lighthouse at First Baptist Church of Shinnston 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 The Lighthouse at First Baptist Church of Shinnston 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.
First Program Time Slots
Second Program Time Slots
Payment Process

1. Please select all the programs you want to register for below.
My Products

Registration Fee (Required) $ 2.00

Jr Futsal First Program $ 35.00

Jr. Futsal Second Program $ 35.00

Jr. Futsal BOTH Programs $ 70.00

Total $ 0.00
Should be Empty:

Junior Futsal Registration Form

Please select which program(s) your child will be attending

Please select an appropriate age/time slot.