QuickFeet Play Days

First Name: *
Last Name: *
Parents Name: *
E-mail Address: *
Address: *
City: *
State: *
Zip Code: *
Phone: *
DOB: *
Age Group: *
League/ Division/ Age:
What best describes your child playing experiences:
Practice Shirt (Youth Sizes): *
Team Jersey (Youth Sizes): *
Team Shorts (Youth Sizes): *
Team Socks (Youth Sizes): *
How did you find out about QuickFeet?

Emergency Contact: *
Name: Phone:
Insurance Company and Policy Number: *

List the allergies and/or medical conditions that QuickFeet should be aware of.

Doctors Information: *
Name: Adress: Phone Number:
By checking here, I hereby give my son/daughter permission to participate the QuickFeet Soccer League. I understand that soccer is a competitive sport that may run the risk of injuries. I agree to hold QuickFeet, Sponsorships, and any other members involved, harmless from all liability associated with my son/daughter and the league. *

I give permission for any medical attention to be administered to my child in the case of an accident, injury, sickness, or any medical occurrence until such time I may be contacted. I also assume responsibility for any such treatment. *

In case of an emergency, if I can not be contacted, I give permission for my child to receive medical treatment. I waive and release QuickFeet and staff from all liability for any injuries and illnesses incurred at the clinic. *

I agree to permit QuickFeet Soccer Training to photograph my child for the sole purpose of marketing. (Optional)



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QuickFeet Soccer Training

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