Golden Touch Soccer Registration Application

www.goldentouchsoccer.net
E-Mail: bmwwin10@goldensoccer.net

Child's Name: D.O.B:

Parent(s)/Guardian: Email:

Address:

City: State: AL AK AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV 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 Family School
Soccer Camp—Pocantico Hills Central School
Soccer Camp—West Harrison Park Turf Field

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.

I acknowledge and concur with the above wavier and release statement and allow the above said camper to participate in the Golden Touch Soccer classes/camps.