Dominate the 18 New Year's Eve Bash! Friday, December 31st, 2022

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dominate the 18 New Year's Eve Bash! Friday, December 31st, 2022 - 9 AM to 12 PM. Ages 8 to 12.

This will be a fantastic camp/training opportunity, allowing players to develop their technical skills through training on dribbling, passing, receiving, 1 v 1 moves, field vision, and shooting. Definitely a training opportunity your child does not want to miss!

Please complete all sections of this registration form in it's entirely truthfully and accurately. Please enter FULL first and last names when entering a person. This form must be completed before the child's participation and must be completed by the parent or legal guardian (age 18 or older) of the participant. All responses on this form will remain confidential (unless for emergency purposes to authorized personnel), and are used for necessary registration requirements and/or in the event of any emergency.

We will be adhering to all current and updated State, local, and CDC Guidelines for this camp as of Dec 1st, 2022. If you do not wish for you or your child to follow these guidelines, we kindly ask that you do not sign up for this camp.
The session will occur from 9 AM to 12 PM (noon) at Test your Metal Fitness and Sports Performance in Easton, PA on Friday, Dec 31st, 2021. Cost is $75 per player ($65 for ENCO or Keystone Athletic players). All players are welcome to this club neutral training opportunity. Limited to the first 20 players! Ages 8 to 12. Price includes a FREE Dominate the 18 Training Shirt!

Players should bring indoor or running shoes, shinguards, a soccer ball with their name on it, water, and a snack (if needed).

At this time, parents are not permitted in the facility (unless there is an emergency) in order to limit the total number of individuals indoors and let to keep everyone safe.

Email *

Cost is $75 per player ($65 for ENCO or Keystone Athletic players). Limited to the first 20 players! *

Paypal: Please search dominatethe18soccertraining@gmail.com OR scan the QR code below. Make sure to enter $75 or $65. Label the payment "New Year's Eve Bash 2022"

Venmo: @GKdominatethe18 OR scan the QR code below. Make sure to enter $75 or $65. Label the payment "New Year's Eve Bash 2022"

If paying by check, please make check out to for $75 or $65 AND mail to DOMINATE the 18 and mail to: PO Box 21560 Lehigh Valley, PA 18002

Cash. Please email dominatethe18soccertraining@gmail.com to make arrangements (must be paid within 7 days of completing registration). Receipt will be provided upon request. $5 discount for cash provided (cannot do both ENCO/Keystone and cash discount/however)

Date of completion by Parent or Guardian *

YYYY

Name of Player (Participant) *

Age of Participant *

If younger than 8 or older than 13, your child is not able to participate. Please exit this form. We will absolutely have training opportunities for players of all ages in the summer. Please email dominatethe18soccertraining@gmail.com about other training opportunities available.

Name of Individual Completing this Form *

Relationship to Player (Participant) *

Date of birth (participant) *

YYYY

Gender of child *

Female

Male

Other

Perfer not to answer

Tshirt Size *

Mailing address *

City, State, Zip *

Current Soccer Club *

Phone #1 (primary contact) *

Phone #2

Email: *

Emergency Contact *

Do you have medical coverage for your child? This question must be a YES in order for your child to participate. *

Yes

Medical Insurance Provider *

Policy Number *

MEDICAL NEEDS of player. If there are no medical needs, please answer NONE. Make sure to state any and all allergies, recent injuries, if your child carries an epi pen (location of), etc. Be specific and clear: *

Parents must sign below prior to child’s participation in the 2022 Dominate the 18 New Year's Eve Bash! If medical assistance is required for illness or injury while attending the camp, I give permission for such care and I certify I have medical insurance, and that the applicant is covered by our family medical insurance. Robert (Bob) Pipech, Dominate the 18 Soccer, associates, Northampton County, Forks Township, ENCO Soccer Club, Test your Mental Fitness and Sports Performance, and any associated entities are all NOT responsible legally or financially in any manner, and will not provide any payment or have any responsibility for any medical, dental, hospital, transportation, or laboratory fees due to injury incurred while participating in the 2022 Dominate the 18 New Year's Eve Bash! I I hereby release Bob Pipech, Dominate the 18 Soccer, and staff of any and all liability from any type of injury as a result of this training. -------------------------------------------------------------------------------------------------------------------------------For your electronic signature, please type your FULL NAME followed by YOUR First and Last Initials, then # --------------------------For example: Person is John Smith. Enter: John Smith JS# *

Date of payment sent/made (As accurate as possible/but does not have to be perfect). Please note again that you must manually enter the amount ($75 or $65 (ENCO or Keystone)) on Paypal or Venmo. If you wish to pay by another method, please email dominatethe18soccertraining@gmail.com. *

YYYY

Waiver form, please go to: https://www.waiverfile.com/b/PipechElitelSoccerTraining/Waiver.aspx?formid=524752d9-fb3e-4478-b461-622d817e476c. After completing (keep this window open), please confirm below. *

Yes, I have completed the waiver form

No, please go to https://www.waiverfile.com/b/PipechElitelSoccerTraining/Waiver.aspx?formid=524752d9-fb3e-4478-b461-622d817e476c before preceding

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms