Registration Form

 

Participants Name:                                                                    

Date of Birth:                                                                                

Parent/Guardian Name:                                                                

Address:                                                                                        

City:                                  State:                   Zip:                        

Phone Number: (home):                           (cell):                            

Emergency Contact and Phone Number:                                        

Email Address:                                                                                

 

Payment: (check one)

Check -                 Check Number:             Amount:                    

Cash Amount:                            

Waiver/Clearance

WE HEREBY AGREE THAT THE FUTBOLKINGS ACADEMY, ITS MEMBERS, COACHES, OFFICERS, AND THE FACILITY, GYMNASIUM, FIELD, AND/OR ANY OF ITS AFFILIATES SHALL NOT BE LIABLE FOR ANY INJURY OR LOSS WHICH MY CHILD OR CHILDREN MAY SUSTAIN WHILE PARTICIPATING IN ACTIVITIES OF ANY KIND. WE AGREE TO INDEMNIFY AND TO HOLD HARMLESS THE FUTBOLKINGS ACADEMY, MEMBERS, COACHES, OFFICERS, OR DESIGNATES FROM ANY CLAIM WHATSOEVER.

Name: ________________________Signature: _____________________________________________Date:__________________