Coppell Development Academy

Coppell Development Academy Soccer After School Program (SAS Program) Elementary School WORK ON BASIC SOCCER SKILLS IN A FUN ENVIRONMENT Wednesdays, starting September 2, 2015 **Meeting Dates: September 2, 9, 16, 23, 30 & October 6, 13, 20 Time: 2:30-4:00pm Location: School Fields Fee: $100.00 (includes healthy snack and T Shirt) Players should come dressed to play with tennis shoes or cleats and must have shin guards REGISTRATION FORM Player Name: _________________________________________________________________________________ Address: _____________________________________________________________________________________ City: _____________________________________________ Zip: ________________________________________ Phone Home: ______________________________________Cell: _______________________________________ E – Mail: ____________________________________________________________Grade: ___________________ DOB: ________________________________ Gender:_________________________________________________ Tee Shirt Size: YS YM YL AS AM AL Emergency Contact ____________________________________________________________________________ Phone Number _______________________________________________________________________________ Known allergies or other pertinent medical information: ____________________________________________________________________________________________ ____________________________________________________________________________________________ Waiver Information: As parent / guardian of the above player, I agree to hold Coppell Development Academy coaching staff members and Coppell Development Academy harmless for injuries and other incidents that may result in my child’s participation in the above activity and club. Furthermore I have current medical insurance coverage, agreeing to assume all responsibilities if such expenses arise for injury. ____________________________________________ Parent /Guardian Name (Printed) ____________________________________________ Parent/Guardian Signature

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Register online by logging in at www.coppellda.com OR mail this form and fee to: Coppell Development Academy SAS Program P.O Box 3872, Coppell, TX, 75019 (check payable to CDA) NOTE: Please do NOT turn form and fee in to the school! P.O Box 3872, Coppell, TX, 75019 [email protected] www.coppellda.com