Child's Name:                    D.O.B: (MM/DD/YYYY)

Parent(s)/Guardian:                   Email:

Address:

City:       State:      Zip:

Home Phone:                    Work Phone:

Emergency Contact:                    Emergency Phone:

Please select one of the following (other questions will appear after selection):

Greek Church Indoor Soccer Skills Class

Advanced Skill Training

Soccer Camp - Holy Child School

Soccer Camp - SUNY Purchase College

Development Class - School of the Holy Child

Development Class - Select

The Golden Touch Soccer assumes no responsibility for injuries or illnesses which my child may sustain as a result of his or her participation in any athletic activities, sports program, the use of equipment, exercise or other activities. I expressly acknowledge that I assume the risk for any and all injuries and illnesses which may result from my child's participation in these activities. I hereby release and discharge the Golden Touch Soccer, its agents, servants and employees from any and all claims for injury, illness, loss or damage, which my child may suffer as a result of his or her participation in these activities.

If there are any issues which may affect your child's participation (i.e., attention behavior), please contact me prior to enrollment. All information will remain strictly confidential.