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Futsal 2016/17 Online Registration Form - TEAM

Please fill out the form on this page very carefully. Once the form is submitted correctly,
you will be taken to a secure payment page where you will be able to take care of payment via PayPal or a credit card.
The online payment includes a processing fee.

ALL FIELDS ARE REQUIRED

 


Select Futsal Session Location

 University of Northwestern - UNW Heritage Middle School - HMS

Select UNW Futsal Session

 UNW-1(Nov 6, 13, 20, Dec 4) UNW-2(Dec 11, 18; Jan 8, 15) UNW-3(Jan 22, 29; Feb 5, 12) UNW-4(Feb 19, 26, Mar 5, 12,) No UNW Session

Select HMS Futsal Session

 HMS-1(Nov 4, 11, 18; Dec 2) HMS-2(Dec 9, 16; Jan 6, 13) HMS-3 (Jan 20, 27; Feb 3, 10) HMS-4(Feb 17, 24; Mar 3, 10) No HMS Session

TEAM Name:



Parent Name:



Parent Email:


Parent Telephone:


Please select phone type:

 Home Work Mobile


Participant's Name:


Participant's DOB:


Participant's Age:


Select Level of Play

 PR C1 C2 C3 REC

Address:


City, State and ZIP code:


Additional Info:


Waiver Acceptance:

 YES


 

WAIVER/EXCLUSION CLAUSE:
(PLEASE READ CAREFULLY & ACKNOWLEDGE ACCEPTANCE & UNDERSTANDING BY CHECKING "YES" ON WAIVER ACCEPTANCE FIELD)
I, the parent/guardian/participant, in registering, understand that he/she/I in attending the above program and using the facilities at which the program is conducted does so at his/her/my own risk. I.S.S.E., and its owners, employees and agents, shall not be liable for any damages whatsoever arising from any personal injury or property loss sustained by participating in or about any programs offered by I.S.S.E. I acknowledge that I am aware of the risk inherent in participating, that considerable physical exertion can be required; and could potentially lead to injuries; possible permanent disability and or death. Participants and parents/guardians assume full responsibility for all injuries and damages which may occur in or about any programs and he/she/I do or does hereby fully and forever release, discharge and hold harmless I.S.S.E., all associated facilities and its owners, employees and agents from any and all claims, demands, damages, rights of action, present and future resulting from or arising out of any participation in any programs or use of facilities. In addition, he/she/I agree(s) to follow all the result in suspension from participation. Also, he/she/I waive all rights to any photos taken for use in any I.S.S.E. publication.