Netripper Futsal Club

Netripper Futsal Club Player Registration - Training Only 2017-2018

Option:  

Required  Price: $399.00
Description: Training only - There will be no League play ( No Matches)
 = Required Field

 

 
 
 
 
  Select Month/Day/Year
 
 
Allergies or Medical Conditions 
 Medical Insurance Company Required
 Name of the Policy Holder Required
 Policy number Required
 Learning Needs or Special Concerns 
PARENT/GUARDIAN: Please type your name plus the last four digits of your SSN.
 Digital Signature for below approvals Required
 Today's Date (mm-dd-yy) Required

 Approvals

I, the parent/legal guardian of the above named player, a minor, recognize the possibility of physical injury associated with futsal/athlete training and in consideration for Netripper Futsal Club accepting the player, I hereby release, discharge and/or otherwise indemnify Netripper Futsal Club, its staff and other associated personnel, including owners of facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the program and/or being transported to or from the same, which transportation I hereby authorize. In addition, I hereby give my consent for the Netripper Futsal Club and Massachusetts Futsal Association to use the visual image of the player and/or concept for purposes that support the mission of the Netripper Futsal Club and Massachusetts Futsal Association.
I, the parent/legal guardian of the above named player, a minor, hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being of my dependent.
I understand that I can cancel the registration before Nov 11th 2017 and receive a refund minus a $35 administrative fee.  After the registration deadline, no refunds will be given.

 CONTACT INFORMATION

GUARDIAN #1

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 
GUARDIAN #2

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 

 Refund Policy

Thank you for registering.  You may cancel your registration before Nov 1st 2016 and receive a refund of your fees minus a $35 administrative fee.  After the registration deadline, no refunds will be given.

Sincerely,

Soorena

--
Soorena Farboodmanesh
Registrar
Netripper FC
--
soorena@netripperfc.com
www.netripperfc.com
617-515-5998

 Contact Info