Brazilian Soccer Club Okinawa

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*SOCCER ACADEMY 2021

Welcome to Brazilian Soccer Academy

The duration of the Fall Season is 4 months starting in September 6th to December 18th,2021.

CHILD INFORMATION

* First and Last name:

* Player's Age:

* Gender:

* Birthdate:

* School Name:

* How did you hear about our Soccer program:

SOCCER ACADEMY INFORMATION

* Soccer Academy Program:

All payments are made at the office

* Soccer Academy Fee:

Uniform Information

If you are a new player you are required to get practice uniform.

*Practice uniform (white jersey, blue short, blue socks, soccer ball, soccer bag)($120)

*I don't need uniform

PARENT/GUARDIAN #1

* First and Last name:

* EMail:

Don't use " - " between the numbers

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact Name:

* Phone:

* Relationship to Player:

WAIVER INFORMATION

*** I, as parent/guardian and undersigned, with legal responsibility for this participant states that he/she understands that the US military and or Brazilian Soccer Club organization, is not and shall not be responsible or liable for any illness to include COVID-19 or injury to the participant or person during activities. The undersigned will not hold the US military and or Brazilian Soccer Club responsible or liable for any damage to property resulting from participation or attendance of Brazilian Soccer Club activities.
I, as parent/guardian and undersigned, with legal responsibility for this participant, hereby forever releases and hold harmless the Brazilian Soccer Club, its employees, agents and representatives from any and all claims of any kind that the participant or the undersigned, or their respective heirs, executors, administrators or assigns may have or claim to have resulting from participation in any Brazilian Soccer Club activities.
Also, the undersigned and the participant authorize the Brazilian Soccer Club to use at its discretion, any photographs or videotape(s) taken of the participant while participating in Brazilian Soccer Club and waive any and all claims that the participant or the undersigned or their heirs, executors, administrators, or assigns may have or claim to have resulting from such photograph(s) or video tapes. I HAVE READ AND UNDERSTAND THE WAIVER STATEMENT, THE REGISTRATION INFORMATION. THE REGISTRATION IS NOT VALID WITHOUT A SIGNATURE. ***

I/we agree with the above *

* indicates required fields

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*SOCCER ACADEMY 2021