1st Touch Soccer

P.O. Box 99 , Ono , PA 17077 | Telephone: (717) 507-3392 | www.1sttouchsoccer.net

Participant's Name:
Age:
Gender:
Parent(s)/Guardian(s) of Participant:
Parent(s)/Guardian(s) of Participant:
Address:
City:
State:
Zip:
Emergency Phone:
Home Phone:
Cell Phone:
Email:

2009-2010 Winter Session #2 will be held on seven Sundays (January 31; February 7, 14, 21, 28 and March 7, 14) * All sessions will take place in Arnold Sports Center at Lebanon Valley College, on courts 3 & 4 . Cost is $75.00 per participant. Please check your t-shirt size and the session you would like to attend:
YS YM YL AS AM AL

	SOLD OUT 5-7 year old boys and girls (3:30 - 4:30 pm)

	SOLD OUT 8-11 year old boys and girls (3:30 - 4:30 pm)

	12-15 year old boys and girls (2:30 - 3:30 pm)

Participant's Insurance Provider/Carrier:
Policy Number:
Name of Participant's Physician:
Phone:
Special Conditions for Participant (e.g. medical, allergies, physical etc.)

I hereby certify that the above named participant is in good physical condition and capable of participation in strenuous physical activity and that all the above information is correct. I hereby give my approval for his/her participation in any 1st Touch Soccer Academy activities. I authorize the director, supervisor or coaches to act for me in their best judgment in any emergency requiring medical attention. I recognize that insurance coverage on any injuries to the participant received during or in connection with 1st Touch Soccer Academy activities is the responsibility of the parent(s) or guardian(s) insurance policy.
By typing your full name below you are signing this registration form.
Signature of Minor Participant's Parent or Guardian :
Date Signed:

Waiver and Release from Liability In consideration of being allowed to participate in any athletic/soccer event sponsored by 1^st Touch Soccer Academy, LLC, and any related events and activities, and intending to be legally bound, I / we the undersigned: 1. Agree that the parent(s) and / or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition(s) and refuse to participate. 2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence, but the action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, I/we acknowledge that there may be other risks not known to us or not reasonably foreseeable at this time. 3. Assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death. 4. Release, waive, discharge and covenant not to sue 1^st Touch Soccer Academy, LLC, its affiliated clubs,, their respective owners, administrators, directors, agents, coaches, and other employees of the organization, any contractors and subcontractors of the organization, other participants, sponsoring advertisers, and, if applicable, owners and lessors of premises used to conduct the event, all of whom are hereinafter referred to as “releasees” from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise. I / WE, HAVING READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I / WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.
By typing your full names below you are signing this Waiver & Release form.
Signature of Minor Participant:
Signature of Minor Participant's Parent / Guardian:
Date Signed:

Cost is $75.00 for each participant. Please make checks payable to "1st Touch Soccer Academy."

Send payments to:

1st Touch Soccer Academy

P.O. Box 99 , Ono , PA 17077