Dates

PO BOX 6182 Aurora, Il 60598 Phone #: (630) 201-0948 [email protected]



Program Name/Dates: _________________________________ Player Name:_____________________ DOB _____________ Age _____ Grade ______ Boy ( ) Girl ( ) Address ____________________________ City ________________ Zip _________ Mother Name: _____________________________ Mother Cell # _______________ Father Name: ______________________________Father Cell # _______________ Emergency Contact: ________________________________________ Parents Primary E-Mail: _____________________________________________________ T-Shirt Size: YS () YM () YL () – AS () AM () AL () By signing below; My child is cleared by a physician to participate in any physical activity required during training. I hereby give permission and certify my child is in good health and able to participate in all soccer activities, I release the coaches, staff, selects to run training sessions, and all others associated with DiDi’s Soccer Academy independent contractors that is from any and all responsibility/liability of physical injury that may be incurred by my child due to participation in the training program. I understand that photographs, recording taken at this program may be used in DiDi’s Soccer Academy advertising with no compensation, financial or otherwise.

PARENT’S SIGNATURE ________________________ DATE ______________________