GEARUP SPORTSPLEX by 6H7lTy5n

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									                                   GEARUP SPORTSPLEX
                               INDOOR SOCCER LEAGUE/CLINIC
                                      REGISTRATION




Name: _______________________________________________________________                    Age: _________ M / F


Address : ___________________________________________________________________________________


Phone number: ________________________________________________________                   Shirt Size __________


1. Emergency contact: ____________________________________________             phone #____________________


2. Emergency contact: ____________________________________________             phone #____________________


Email address: _______________________________________________________________________________




                     CONSENT TO PARTICIPATE and MEDICAL AUTHORIZATION


I, ______________________________, give consent for ______________________________ to participate in the
  GearUp Indoor Soccer League/Clinic. I hereby release GearUp and it’s employees from any liability due to injury
  incurred during this activity.

I give GearUp consent to authorize emergency medical treatment for my child in the event that I (or other emergency
  contact listed) cannot be reached. My child is medically fit to participate in this program.



Parent/Guardian Signature _______________________________________________              Date__________________

								
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