INDIVIDUAL & GROUP SOCCER SESSION FORM
Brazil Soccer USA

For initial sessions we require a wet copy of signature. Please fill out form, print, sign and bring the day of session. Please do not forget to submit electronically. You have the option to have a copy sent to you. Thank you for your cooperation. Staff and Operations of Brazil Soccer USA

Email address *
Parent or Guardian
Your answer
Name of Player
Your answer
Player's Position
Your answer
Name of Team | Group Lessons Only
This section only pertains for applicants signing up for group lessons.
Your answer
Name of Supervisor Coach | Group Lessons Only
This section only pertains for applicants signing up for group lessons.
Your answer
Gender
Player Skill Set
Session Type
City
Your answer
State
Your answer
Cell Phone
Your answer
Additional Phone
Your answer
Age Of Child
Your answer
Available Days *
Required
Choose An Available Time *
I grant my child, named above, permission to participate in individual and/or group soccer lessons held by Brazil Soccer USA. I understand that these lessons are for soccer players, as such, my son/daughter is eligible to participate. I waive all claims of liability against Brazil Soccer USA and Gerhard Benthin, its directors, and employees, the liability of the event, or any other affiliated sponsoring body, corporate affiliated sporting body, corporate affiliate, or associate staff members. My son/daughter will participate in the program/lessons using the proper protective equipment, he/she does so at his/her own risk with my permission. As the parent or legal guardian of the above named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor Of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my dependent. Brazil Soccer USA has the right to use any photos taken
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