INSTINCT4GOAL
REGISTRATION/WAIVER FORM
NAME: _______________________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: _______________ STATE: _______ ZIP: __________ AGE: ________
CONTACT #: (C) _______________ (H) _________________ (W)__________________
EMAIL: ________________________________________________________________________
EMERGENCY CONTACT AND #: _________________________________________________
KNOWN ALLERGIES/Medical needs: ______________________________________________
CAMP #: 1____ 2 ____ 3 ____ 4____
Statement of Understanding and Release of Liability
By signing below, I accept full responsibility for any injury which may arise from________________ participation in any and all of Neathan Gibson's Camps. I hereby release, cancel, acquit and forever discharge Neathan Gibson, all heirs, executors, administrators, agents, employees, directors, officers, shareholders, members, subsidiaries, affiliates, successors and assigns from any and all past, present and/or future claims, demands, losses, damages, causes of action or other liabilities (including attorney fees and costs in connection there with of every nature, character and description known or unknown in any way growing out of, any and all personal injuries, or property damage which ___________________________ (I or We) may know or hereafter have for ourselves and as the parents and or legal guardian of said minor(s), and also for any and all claims, rights of action or damages, which said minor(s), and have or may have hereafter resulting from participation in NEATHAN GIBSON'S soccer programs.
Parent signature: ___________________________ Date: _________________
Guardian Signature: _________________________ Date: _________________
Mail Check to: Neathan Gibson
3523 Breezewood SE
Grand Rapids, MI
49512
REGISTRATION/WAIVER FORM
NAME: _______________________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: _______________ STATE: _______ ZIP: __________ AGE: ________
CONTACT #: (C) _______________ (H) _________________ (W)__________________
EMAIL: ________________________________________________________________________
EMERGENCY CONTACT AND #: _________________________________________________
KNOWN ALLERGIES/Medical needs: ______________________________________________
CAMP #: 1____ 2 ____ 3 ____ 4____
Statement of Understanding and Release of Liability
By signing below, I accept full responsibility for any injury which may arise from________________ participation in any and all of Neathan Gibson's Camps. I hereby release, cancel, acquit and forever discharge Neathan Gibson, all heirs, executors, administrators, agents, employees, directors, officers, shareholders, members, subsidiaries, affiliates, successors and assigns from any and all past, present and/or future claims, demands, losses, damages, causes of action or other liabilities (including attorney fees and costs in connection there with of every nature, character and description known or unknown in any way growing out of, any and all personal injuries, or property damage which ___________________________ (I or We) may know or hereafter have for ourselves and as the parents and or legal guardian of said minor(s), and also for any and all claims, rights of action or damages, which said minor(s), and have or may have hereafter resulting from participation in NEATHAN GIBSON'S soccer programs.
Parent signature: ___________________________ Date: _________________
Guardian Signature: _________________________ Date: _________________
Mail Check to: Neathan Gibson
3523 Breezewood SE
Grand Rapids, MI
49512