EmailMe Form - City of Miami Gardens

PARENTS INFORMATION

Mothers Name

Fathers Name

Would you like to help our program to become a volunteer Coach? *

Yes

No, not at this time

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Cell Phone Number #1 *

### - ### - ####

Cell Phone Number #2

### - ### - ####

Email #1 *

Email #2

Which Park will you be practicing at?

AJ King Park (mon / wed 6:30-8:00pm)

Norwood Park (Tue / Thurs 6:30-8:00pm)

CHILD #1 INFORMATION

#1: Child's Full Name *

#1: Date of Birth: *

#1: Gender *

Boy

Girl

#1: Child's School Name *

#1: Grade *

#1: Uniform Size *

CHILD #2 INFORMATION

Child #2: Program Option *

Only One Child

2 Children

#2: Child's Full Name

#2: Date of Birth

#2: Gender

Boy

Girl

#2: Child's School Name

#2: Grade

#2: Uniform Size

OTHER INFORMATION

Medical Concerns

Please insert (if applicable) any health concerns and or conditions of your children which we may need to know about

TERMS & CONDITIONS

I have read and agree to the Terms of Service *

Yes, I agree.

I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the soccerprogram, other than imposed by law. I also allow ALM Sports to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email admin@almsports.com. I confirm that my personal insurance is correct given on registration form and bears responsibility in case of accidents. I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.