Please choose play session or sessions *

Boys U8-U6 | 4v4 Mini Soccer | Wednesdays | June 6, 13, 20, 27, | 5:30 pm to 6:30 pm | $135.00

Player Information *

First Name

Last Name

Date of Birth *

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DD

YYYY

Has your child ever played soccer before? *

Yes

No

Father's Name *

First Name

Last Name

Mother's Name *

First Name

Last Name

Cell Phone | Father *

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Cell Phone | Mother *

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

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Consent and Liability Waiver - Release of all claims – I, the undersigned, as parent or legal guardian, give my consent for my child, identified herein. As lawful consideration for my minor child being permitted to participate in the Soccer Clique LLC. Class, Program, Camp, Clinic, Session and Development Academy at local parks, fields or schools, or any other activity associated with, hosted by, or related to Soccer Clique LLC. I agree that neither my minor child nor I will make a claim against, sue, or prosecute Soccer Clique LLC. and/or their agents, sponsors, suppliers, and employees for any damages whatsoever including, but not limited to, death, personal injury or property damage which my minor child may sustain as a result of my child's participation in these sporting activities. This release is intended to discharge in advance Soccer Clique LLC. and/or their agents, sponsors, suppliers, and employees from and against any and all liability, including for negligent actions, arising out of or connected in any way with my minor child's participation in the class, program, camp, clinic, session and development academy or any other activity except for liability that may arise out of the willful or wanton misconduct of Soccer Clique LLC. and/or their agents, sponsors and employees. I FURTHER UNDERSTAND THAT SPORTS INVOLVE PHYSICAL CONTACT BETWEEN PLAYERS, THAT SERIOUS ACCIDENTS OCCASIONALLY OCCUR DURING SUCH SPORTING ACTIVITIES, AND THAT PARTICIPANTS IN SUCH SPORTING ACTIVITIES OCCASIONALLY SUSTAIN SERIOUS PERSONAL INJURIES (INCLUDING DEATH) AND/OR PROPERTY DAMAGE, AS A CONSEQUENCE THEREOF. KNOWING THE RISKS OF PARTICIPATION, I NEVERTHELESS, HEREBY AGREE THAT MY MINOR CHILD AND I ASSUME THOSE RISKS AND HOLD HARMLESS AND RELEASE FOR MYSELF, MY MINOR CHILD AND ALL OUR SUCCESSORS, HEIRS, ASSIGNS, SOCCER CLIQUE LLC. AND/OR THEIR AGENTS, SPONSORS AND EMPLOYEES WHO (THROUGH NEGLIGENCE OR CARELESSNESS) MIGHT OTHERWISE BE LIABLE TO ME, MY MINOR CHILD (OR OUR HEIRS OR ASSIGNS) FOR DAMAGES. I FURTHER UNDERSTAND THAT IN THE EVENT OF A MEDICAL EMERGENCY SOCCER CLIQUE LLC., WILL CALL EMS TO RENDER ASSISTANCE AND THAT I WILL BE FINACIALLY RESPONSIBLE FOR ANY AND ALL EXPENSES INVOLVED. I attest that I am eighteen (18) years old or older and that my child is physically fit and has no known medical conditions which prohibit participation in this sport. My child and I agree to follow all laws, rules and guidelines regulating the conduct of the class, program, camp, clinic, session and development academy. I understand and agree that my child and I are responsible for the mechanical and/or operating condition of any and all sporting equipment provided by my child or by me for my child's use, and I agree that my child and I will continuously inspect and maintain all equipment used, even if we have obtained any of the equipment from Soccer Clique LLC, their agents, sponsors, suppliers and/or employees. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY FOR MYSELF AND MY CHILD AND A CONTRACT BETWEEN MYSELF, MY CHILD AND SOCCER CLIQUE LLC. AND THEIR AGENTS, SPONSORS, SUPPLIERS AND EMPLOYEES, AND I HAVE SIGNED IT OF MY OWN FREE WILL. I also hereby consent and agree that Soccer Clique LLC., has the right to take photographs and video of my child and myself and anyone associated with my family during Soccer Clique class, program, camp, clinic, sessions and development academy. These photos and video may be used on the company websites, company social media pages, promotional and marketing material without compensation. I understand that my child’s name and identity will not be revealed. *

I agree to all terms of the Consent and Liability Waiver

Parent | Guardian Signature *

Please fill in your name as proof of signature.

First Name

Last Name

Date Signed *

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DD

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