Lightning Soccer Club Spring 2012 U8 Co-Ed Clinic Registration
Please complete the following to sign-up for Spring 2012 U8 Co-Ed Clinic (non-travel) Program.

This online form is required, so please make sure to hit the SUBMIT button at the bottom of the form. A GoogleDoc confirmation window will then pop-up thanking you for registering -- that is your confirmation.

This is an open Clinic, available to any player who wishes to focus on their soccer development, but limited to 12 kids. Please be sure to mail in in the following:
1) A USYSA Form
2) $175 Fee, payable to Lightning Soccer Club.
Write player's name & U8 Clinic on the memo line.

If you have any questions or difficulties, please email Kris Graham or Donna Richardson at lightningsoccerclub1983@gmail.com or call the Lightning SC office at 802-649-7096.

*When filling out this form, please capitalize the first letter of an entry, and then lower case letters.
For example, John Smith-- NOT john smith or JOHN SMITH.
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First Name *
(Legal First Name -- not a nickname or common name)
Last Name *
(Legal Last Name -- not a nickname or common name)
Gender *
Player's Date of Birth *
xx/xx/xxxx -- please use this format
CONFIRM Player's Date of Birth *
xx/xx/xxxx -- please use this format
Comments
Comments for the coaches; injuries, or tryout information.
Parent #1 First & Last Name *
Paremt #1 Cell Phone *
xxx-xxx-xxxx -- Include Area Code
Parent #1 Email Address *
(Please make sure it's correct)
Parent #2 First & Last Name *
Parent #2 Cell Phone *
xxx-xxx-xxxx (include area code)
Parent #2 Email Address *
(Please make sure it's correct)
Player's Primary Home Phone# *
xxx-xxx-xxxx -- Include Area Code
Player's Primary Home Street Address *
Apt, Floor, Suite, etc.
City *
State *
ZIP Code *
Medical Conditions
List any medical conditions we should be aware of
Emergency Contact Name *
First & Last Name
Emergency Contact Phone# *
Include Area Code
Accept *
I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of Lightning SC (LSC), its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for LSC accepting the registrant for its soccer programs and activities (the "Programs"), I hereby release, discharge, and/or otherwise indemnify LSC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.  As the parent or legal guardian of the above-named player, I hereby give my 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 the life, limb, or well-being of my dependent.
Required
Accept *
As Parent/Legal guardian I give permission to Lightning Soccer Club to use soccer related photos of my son/daughter in brochures, flyers, press releases, news articles, and website, as well as other potential mediums for which Lightning Soccer Club could be associated. I also agree and allow Lightning Soccer Club to forward my son/daughter soccer related photos to various mediums for related purposes such as, Team Pictures; Individual Achievements; Team Awards and Individual Recognition.
Submit
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