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| soccer REGISTRATION FORM Participant’s Name _______________________________________________________ Phone ___________________ Street ____________________________________ City __________________________ Zip ______________________ Age (at start of session) _________________ Birthdate ____________________ male female parent/Guardian Name(s) ___________________________________________________________________________ Email ______________________________________________________________________________________________
league Play
instruction T-shirt Size (Please circle -- LEAGUE PLAY ONLY) Child: 10-12 14-16 Adult: S M L (no exchanges) YES, I WOULD LIKE TO COACH. NAME _______________________________________________ PHONE __________________________________________
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PAYMENT POLICIES YOU WILL NOT BE INVOICED. Payment is due in full at the time of registration. Payments not received by the first game will be assessed a late fee. If payment is not received by the second game, your child will not be allowed to participate until payment has been received. The full session fee is due — there is no pro-rating for missed games or instructional classes. PAYMENT METHODS: Payment can be made with cash, check, money order or credit card (MasterCard and Visa only). ALL CASH PAYMENTS MUST BE MADE TO THE FRONT DESK ATTENDANT AND RECEIPT ISSUED. Non-cash payments can be put in envelopes and put in the payment box located at the front desk. Make all checks payable to CHAMPIONS FOR LIFE. There is a $20.00 fee for returned checks. RELEASE By their very nature, sports or activities such as gymnastics, martial arts, soccer, tennis or any other activity that involves motion carry a risk of physical injury. No matter how careful the athlete and instructor are, the risk cannot be eliminated. Potential injuries range from minor injuries, such as bruises to more serious injuries such as broken bones, dislocations and muscle pulls, to catastrophic injuries such as permanent paralysis or even death from landings or falls on the back, neck or head. Participation in these activities carries with it a reasonable assumption of risk. By signing this release, I hereby for myself, my children adopted or otherwise, my heirs and executors, waive and release any and all rights against Champions For Life, their agents or representatives; for any injury or damages that may be suffered by me, my children adopted or otherwise, in connection with my association or entry in gymnastics, martial arts, soccer, tennis or other activities sponsored by Champions For Life. In case of emergency, contact _____________________________________________ Phone _____________________________________________ Relationship _____________________________________________ Parent/Guardian Signature _____________________________________________ Date______________________ How did you hear of us? (Please check one) FOR OFFICE USE ONLY
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