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Registration Form
Name:____________________________________________________________
 
Address:__________________________________________________________
 
City:_____________________________________________________________ 
 
State:__________________________________________ Zip: ______________
 
DOB:___________________________________________________________
 
Email: __________________________________________________________
 
Date of Camp/Location: _____________________________________________
 
Camp: (circle)  Beginner    Intermediate I    Intermediate II    Intermediate III      Advanced
 
Parent’s Name:_______________________________________________________
 
Home Phone:________________________________________________________
 
Emergency Contact:___________________________________________________
 
Emergency Phone:____________________________________________________
 
Camp T Shirt Size: YS  YM  YL  AS  AM  AL

 

Return Registration To:

Quick Hands Goalkeeper Training. 179 Cherry Lane. Avon Lake, Ohio 44012

 

Make Checks Payable to: Quick Hands Goalkeeper Training

 

Waiver/Exclusion Clause:

I, the undersigned parent/guardian/participant of age, in enrolling for a camp/clinics, understand that in attending any sports program and using the facilities does so at participant’s own risk. Quick Hands Goalkeeper Training, its owner, camp director and staff, shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant and family on the premises. Participants, parents and guardians assume full responsibility for all injuries and damages which may occur in or about any programs on the premises and does hereby fully and forever release, discharge and hold harmless Quick Hands Goalkeeper Training, and all associated facilities and its owner, camp director and staff from any and all claims, demands, damages, rights of action, present or future resulting from or arising out of any person’s participation in any program or use of its facilities. In addition, participant agrees to follow the rules of play and conduct set by Quick Hands Goalkeeper Training Participant, parent/guardian understands that failure to do so may result in suspension from participation.  I, the undersigned parent of/ guardian of/ legal age participant _____________________do hereby grant authority to the staff of Quick Hands Goalkeeper Training to render a judgment concerning medical assistance or hospital care in the event of an accident or illness during my absence.

 

Signed: _____________________________________