2021-22 Winter Training Girls

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Description: 
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 Player Information

 
 
 
 
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  AGE GROUP ('06-'07) 
 
                    
 
 
 Grade ('06-'07): 
 GPA: 
 ACT: 
 SAT: 
 Grad. Date: 
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 Emergency Contact 
 Emergency # 
Comments 
 Insurance Name Required
 Policy # Required
 Group Name Required
 Club Team Required
 Club Team Coach Required
 Club Team Coach Email Required


 Waiver

PLEASE READ WAIVER CAREFULLY 
By checking the box you agree, warrant and covenant as follows: 
WAIVER AND RELEASE OF LIABILITY 
In consideration of being allowed to participate in any way in the KPA sports program, and related events and activities, 
the undersigned: 
1: Agree that prior to participating, they each will inspect the facilities and equipment to be used, and if they believe anything is unsafe, they will immediately advise their coach or supervisor of such condition(s) and refuse to participate; 
2: Acknowledge and fully understand that each participant will be engaging in activities that involve risks of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time; 
3: Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death; 
4: Release, waive, discharge and covenant not to sue the KPA, its affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as “releases”, from demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the release or otherwise. The undersigned have read the above waiver and release, understand that they have given up substantial rights by signing it and sign in voluntarily.
 

 


 CONTACT INFORMATION

GUARDIAN #1

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

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

 Refund Policy

Contact kpasoccer@gmail.com if you need to request a refund.  

Thank You  

 Contact Info