Soccer Day Off Clinic, October 3 (L5-GFS-SDOC-241003)Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.PaidYesNoPlayer InformationName *FirstLastLayoutBirth Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age *Medical InformationDoes child have any medical condition that affect performance, or in which we should be aware? *YesNoYou answered Yes to the above, please explain. *Anything else we should know about your child?Player/Child Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent Information (Parent #1)Name *FirstLastPhone, Primary *Is Primary Phone *HomeMobileWorkPhone, SecondaryIs SecondaryPhoneHomeMobileWorkEmail *EmailConfirm EmailDo you want to include Parent #2 Contact Information? *YesNoInformation for parent #2 is not required, but is helpful for communications and in event on emergencies.Parent Information (Parent #2)Name *FirstLastPhone, Primary *Is Primary Phone *HomeMobileWorkPhone, Secondary *Is Secondary Phone *HomeMobileWorkEmail *EmailConfirm EmailEmergency ContactsName Emergency Contact #1 *FirstLastPhone *Relation to child *Name Emergency Contact #2FirstLastPhoneRelation to childPoliciesAccept Release of Liability *YesNoPlease read and agree to our Release of Liability agreement. You must accept the agreement before your child can participate in our programs.Accept Photo Policy *I AcceptPlease read and agree to our Photo Policy. You must accept our photo policy before your child can participate in our programs. Photo Policy Level 5 Athletics takes photos at many clinics, camps and sessions. Unless expressly cited in writing to exclude my child, I understand that the images may be used in Level 5 publications and marketing materials.Submission & Registration FeeRegistration Fee When you submit this form, you will be directed to our payment portal. Payments are only refunded if the camp is canceled. No other refunds will be given. Please enter the child's name during checkout. Thank you! Registration is not complete until payment has been received. Submit
