Soccer Clinics

Player Name (required)

Age (required)

Level (required)

Address (required)

City (required)

State (required)

Zip (required)

Phone (required)

Emergency Contact

Name (required)

Cell (required)

Phone (required)

Waiver Information

I certify that my child(ren) is in good health and is/are able to participate in physical activity including all sports. I agree to hold SPD, its agents and employees harmless for any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child(ren) to receive emergency medical treatment.

Parent Signature (required)

Credit Policy

A voucher for the full program fee will be issued for any cancellation prior to the program. No cash refunds.
I, the undersigned hereby certify I am legal guardian of above camper.

Legal Guardian Name: (required)

Legal Guardian Signature: (required)

Date (required)