Boca Juniors / AES After School Enrichment Soccer Class Registration
Event Timing: (First Session) October 22nd - December 10th // Mondays // 2:45 - 3:45 PM
Event Address: 17551 Miranda St. Encino, CA 91316
Contact us at: Boca Juniors (818)574-8006 // AES (818)609-8421
Student's First and Last Name *
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Student's Date of Birth *
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Parent's Name *
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Parent's Email *
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Parent's Phone Number *
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Student's Grade *
Participant Release and Waiver *
***PLEASE SIGN (by typing your name) AND DATE BELOW THAT YOU AGREE TO THE FOLLOWING TERMS.*** I understand that there are risks associated with playing all sports and field related activities. In consideration for the privilege to use the facility, my signature indicates that I assume the risk of any injuries that myself or my children/wards may sustain while participating in any activity and for any injuries which myself or my children/wards may sustain while on the premises of The Academy for Enriched Sciences. I insure that I am, or my child is, physically and mentally able to participate in physical activities and have been examined by a licensed medical physician within one (1) year prior to attending this event .I give permission for trainers and coaches or contracted health care to start preliminary treatment and arrange transportation for me or my child to a local Emergency Room in the event that I or my child become(s) ill or injured. By signing this Waiver and Liability Agreement, I acknowledge that I HAVE READ AND FULLY UNDERSTAND AND AGREE TO ALL OF ITS TERMS AND CONDITIONS INCLUDING PERMISSION TO TREAT AGREEMENT. I further state that I have executed this waiver and liability voluntarily and with full knowledge of its significance to be binding on my, my heirs, executors, administrators and assigns.
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