Please print form, fill it out, and bring it to the first session!
Player's Full Name: ________________________________________ Sex: _______
Birth Date: _________________________ Middle Initial: __________
Parent's Name(s): _________________________________________
Address: ________________________________________________
City: ________________________________ Zipcode: ________________
Home Phone Number: ___________________ Cell: _______________________
E-mail: __________________________________________________
Allergies/Special Considerations: _________________________________
Kinderkicks Participation Waiver
I understand one requirement of eligibility for athletic participation is adequate insurance coverage against injury in practice or performance. I, the undersigned, do hereby release KINDERKICKS, LLC instructors and administrators from responsibility in case of illness or injury of my child while participating in the Kinderkicks program. I also give my permission for treatment of illness or injury that may be sustained while performing said activities. I hereby state that I am the legal guardian of ____________________________(Child's Name) and I am authorized to make this decision. Lastly, I understand that there are NO cash refunds and $20 for all returned checks.
Parent/Guardian Signature: _______________________________________________
Date: _______________________________________________