Girls Futsal Program
Step 1 of 2: Submit
Participant Name:
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Date of Birth:
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Age Group
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Select an option:
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4-7 year old
8-11 year old
Gender: Female Participants Only
Participant Size:
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Select an option:
Youth Extra Small
Youth Small
Youth Medium
Youth Large
Adult Small
Does the participant have any Illness and/or has been exposed to Covid-19 (if yes, please explain):
Please note that it is your responsibility to let us know if the participant has been exposed to Covid-19 or is a close contact with someone in their household or school at anytime during the event.
Parent or Guardian:
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Home Phone:
Cell Phone:
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Email Address:
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Registration Fee: $85
Pay By:
Direct Deposit
Cash
Check
Participation includes possible exposure to illness from infectious diseases including but not limited to influenza and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness does exist.
I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for the participation; and,
I willingly agree to comply with the terms for participation in regards to protection against infectious diseases. If, however, I observe and any significant hazard during my presence or participation, bring such to the attention of an official.
By submitting this form, you hereby agree that Footy Promotions / Footy Force Futsal Academy, its members, coaches or officers, shall not be liable for any and all illness, disability or injury
or loss which my child or children may sustain while participating in activities of any kind, whether sponsored by or under the supervision of the Footy Promotions / Footy Force Futsal Academy.
We agree to indemnify and to hold harmless Footy Promotions / Footy Force Futsal Academy, its members, coaches, officers or designates from any kind of claim whatsoever.
The Participant, and the Parent(s) or Guardian(s), if the Participant is a minor child, grant authorization to Footy Promotions / Footy Force Futsal
to use photographs and video of the Participant for publicity purposes including Website, social media and print advertising content.
Parent or Guardians Please Initial Here To Sign:
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Date:
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Please note that there are no refunds once the participant has started the Girls Futsal Program
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indicates required fields