2017 Academy Registration Form
ISFC 2017 Academy Registration Form Ages: Kindergarten – 5th Grade General Information: Player Name:________________________________________ DOB (mm/dd/yy):_____/_____/_____ Parent/Guardian Name(s):_______________________________________________________ Street Address:_____________________________________ City:____________________ Zip Code:___________ Phone: (H)____________________ (C) _____________________ Email(s):___________________________________________________________________________________________ Current Grade:____________________ Age:__________ Gender: Male / Female (Circle Gender) Are you interested in playing travel soccer for the ISFC? Y ES NO (Circle Answer) Please list any medical conditions: __________________________________________________________________________________________________ __________________________________________________________________________________________________ Contact Information: Dates: Indiana Southwest Futbol Club October 29, 31 PO Box 264 November 5, 7, 12, 14 Jasper, IN 47546 [email protected] 5:45-7:00 Price: Location: $50 per player Schroeder Soccer Complex $100 max per family (siblings) nd 405 W 2 St. CHECKS PAYABLE TO “ISFC” Jasper, IN 47546 Academy is a fun, exciting, learning atmosphere where players will have fun while learning the game of soccer. Academy participants will receive individual instruction and group instruction to better themselves as a soccer player.
or visit our website at: www.myisfc.org
*Waiver (MUST BE SIGNED) I hereby for myself, my minor child, my administrators, heirs and assigns waive and release any and all right and claims for damages, including negligence, I may have against the Indiana Southwest Futbol Club, Inc., its board of directors, officers, commissioners, chairpersons, referees, and/or coaches, for property damage or personal injury, including death that may arise or grow out of my minor child’s participation in ISFC’s Soccer Program. I also agree to indemnify and hold harmless the Indiana Southwest Futbol Club, Inc.; its board of directors, officers, commissioners, chairpersons, referees, and/or coaches any claim, damages, expenses or action, including attorney fees, assessed or brought against them because of my acts or omissions or the acts or omissions of my minor child. I give ISFC my permission to use photographic images of my child or website and/or advertising purposes. X___________________________________________________
ISFC ADMINSTRATION USE ONLY Age Division:
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
(Circle Age Group)
Check # __________
Cash __________
Total amount: _____________
5th Grade
or visit our website at: www.myisfc.org
*Waiver (MUST BE SIGNED) I hereby for myself, my minor child, my administrators, heirs and assigns waive and release any and all right and claims for damages, including negligence, I may have against the Indiana Southwest Futbol Club, Inc., its board of directors, officers, commissioners, chairpersons, referees, and/or coaches, for property damage or personal injury, including death that may arise or grow out of my minor child’s participation in ISFC’s Soccer Program. I also agree to indemnify and hold harmless the Indiana Southwest Futbol Club, Inc.; its board of directors, officers, commissioners, chairpersons, referees, and/or coaches any claim, damages, expenses or action, including attorney fees, assessed or brought against them because of my acts or omissions or the acts or omissions of my minor child. I give ISFC my permission to use photographic images of my child or website and/or advertising purposes. X___________________________________________________
ISFC ADMINSTRATION USE ONLY Age Division:
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
(Circle Age Group)
Check # __________
Cash __________
Total amount: _____________
5th Grade
