LIC Youth Soccer Academy Registration Form-Spring Season at Astoria Park
*No Refunds
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NEW Location and brand new soccer field at Astoria Park with Coach Nikola Dokic! Spring Soccer 2020 Program, every Saturday March/21 through June/6/2020 (no class on May 9th)- $300 per player. Ages: 4,5 years 6,7 years and 8,9 years, Day | Time: Saturday from 4pm-5pm Ages: 10,11 years 12,13 years and 14,15 years, Day| Time: Saturday 5pm-6pm Contact : email licsoccer@yahoo.com Location: Astoria Park Soccer Field, 19 19th St, Astoria, NY 11105
Player's First Name *
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Player's Last Name *
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Player's date of birth *
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Address: *
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Telephone number: *
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Email address: *
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Parent/Guardian's First Name: *
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Parent/Guardian's Last Name: *
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Please Check the age group you are registering for: *
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Consent to photograph, film, or videotape: I hereby authorize Long Island City Youth Soccer to take photographs or video footage, electronic images or movies of my child or us participating in the program and to use same in promotional or advertising materials for Long Island City Youth Soccer flyers, on the internet, and all other forms of media, and we waive any right to compensation or other rights related to such use. I acknowledge that I have read and understand and agree to all of the above terms and conditions of the Long Island City Youth Soccer program. *
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RELEASE OF LIABILITY: I agree by signing below that I wave the risk of any type of injury that may occur during the games or training sessions of Long Island City Youth Soccer while I am participating. I hereby release waive discharge and covenant not to sue Long Island City Youth Soccer, its owners, promoters, sponsors, officials and employees involved in organizing this event. I also assume full responsibility for any loss, liability, death or cost that may incur due to the negligence or the result of any action by them, around or upon the playing areas while they or and/or I am competing, participating and observing working for and/or any other way associated with the event within premises. *
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I understand that Long Island City Youth Soccer reserves rights to suspend or expel any player from the club for any type of in disciplinary action including excessive absences. I also understand that once player joins Long Island City Youth Soccer there will be no membership refund applicable. *
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A copy of your responses will be emailed to the address you provided.
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