Warriors Soccer Clinic 2018
This pre-season clinic is intended for any girl entering the 3rd through 8th grade this fall. The program will run daily (Monday, August 20; Tuesday, August 21; Wednesday, August 22) from 9:00am-11:30am at the LSRHS turf field. The program will be run by returning varsity players and overseen by a member of the LSRHS Girls Soccer Program coaching staff. The cost of the clinic is $90 per clinic participant. Registration is complete once you have completed this form and the $90 registration fee has been made to LSRHS Girls Soccer and received by Coach Grant: LSRHS Girls Soccer, c/o Coach Grant, 390 Lincoln Road, Sudbury, MA 01776. Please e-mail lsgirlssoccer@gmail.com if you have any questions. Thank you and we hope to see you at our clinic in August!
~ LSRHS Varsity Girls Soccer

By completing this form, you (a legal parent/guardian of the clinic participant named below) recognize: (1) There are risks of injury or damage resulting from such participation. Any activity involving contact, motion or height creates the possibility of serious injury, including permanent paralysis and even death; (2) There may be costs in the event of such injury or damage and all costs, for the injury or damage and for any insurance against such risks, are the responsibility of the undersigned.

In the event of an injury requiring more than basic first aid, it remains the responsibility of the parent/guardian to make arrangements for medical care and transportation of his/her child. The clinic will make every reasonable effort to contact the parent/guardian in the event of such injury and provide an adult to accompany the injured athlete.

Emergency information is based on the contact information you provide below. You should also notify your physician that he/she is authorized to render care in the event that you cannot be contacted. An ambulance will transport clinic participants with serious injuries to the nearest hospital. The emergency room will not treat your child (except for life threatening injuries) unless a parent/guardian or personal physician gives injury specific approval.

By clicking the following checkbox, I am granting permission for my daughter (the clinic participant, named in the fields below) to participate in the 2018 Warriors Soccer Clinic as it has been described above. *
Required
Please provide, as an e-signature for the above, your full legal name. *
name of parent/guardian
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Primary Phone # *
Your answer
FIRST Name (of the clinic participant) *
first name only
Your answer
Preferred Name (nickname of the clinic participant)
Your answer
LAST Name (of the clinic participant) *
last name only
Your answer
Grade (as of 9/1/2018) *
(this is information about the clinic participant)
Street Address *
Your answer
City/State *
Zip Code *
Your answer
Full Name (First and Last) of Emergency Contact #1 *
Your answer
Relationship (to clinic participant) *
of emergency contact #1
Your answer
Primary Phone # *
of emergency contact #1
Your answer
Secondary Phone #
of emergency contact #1
Your answer
Email *
of emergency contact #1
Your answer
Full Name (First and Last) of Emergency Contact #2
Your answer
Relationship (to clinic participant)
of emergency contact #2
Your answer
Primary Phone #
of emergency contact #2
Your answer
Secondary Phone #
of emergency contact #2
Your answer
Email
of emergency contact #2
Your answer
Insurance Provider *
Your answer
Policy Number *
Your answer
Physician Name *
Your answer
Physician Phone # *
Your answer
Allergies
Your answer
Existing Medical Conditions
Your answer
Current Medications
Your answer
Other Information
Your answer
Photo/Video Release: Permission is hereby given for the Warriors Soccer Clinic to use any images (digital, photographic, video and audio) or likenesses of my daughter (the clinic participant) in promoting the Warriors Soccer Clinic and in other ventures or media directly relating to the Warriors Soccer Clinic. *
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