Hilton Parma Soccer Club - Training Clinic Registration Form

Page One

Complete this form and click submit at the bottom of the page to register.

A red * indicates a required field.

Payment will be required upon arrival at first session. Cash or checks will be accepted. Make checks payable to HPSC.

Have a question? Contact us at HiltonHeatVP@yahoo.com

1. Select a session(s) Required Question

	Goalie Clinic ($25) - Saturday's @ All Star Sports (2/6, 2/20 and 3/6)
	Co-Ed Training Clinic ($45) - Saturday's @ All Star Sports (8 sessions)

2. Household Information:

Parent First Name Required Question

Parent Last Name Required Question

Street Address Required Question

City

State

Zip Code

Email Address Required Question

Home Phone Number

3. Player Name (first & last) Required Question

4. Player Age: Required Question

5. Player Gender Required Question

MaleFemale

6. Please indicate any medical concerns that coaches should be aware of (i.e. allergies, medications, asthma or physical limitations).

7. Disclaimer: I, the parent guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the
USYSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer
and in consideration for the USYSA accepting the registrant for its soccer programs and activities of the "Programs". I
hereby release, discharge and/or otherwise indemnity the USYSA. Its affiliated organizations and sponsors, their
employees and associated personnel including owners of fields facilities utilized for the Programs and/or being
transported from the same. Which transportation I hereby authorize.

Consent for medical treatment (Minor): As the parent or legal guardian of the above named player, I hereby give consent
for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This Care may be
given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent. Required Question

I Accept