Summer Academy U14-U19 Registration
Event Timing: July 26th- August 21st 2022
Event Address: Pineview Soccer Fields. N Dewey Ave, Reedsburg, WI 53959
Contact us at (608)495-3837 or olesocceracademy1@gmail.com
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Email *
Player's Name *
Date of birth *
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Gender *
Address *
Parent's Name *
Parent's Name
Email *
Phone number *
Allergies *
Medical Conditions *
Emergency contact(name & phone number) *
Waiver
I hereby consent and understand that all soccer academy activities are public events and that the soccer academy, or those in attendance, may take photographs for use in publications, web sites, and news releases without my written consent.

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the soccer academy, US club soccer, their sponsor, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in US Club soccer programs and/or being transported to or from the same, which transportation I hereby authorized. No insurance is available for accidents or injuries that may occur during recreation programs. The Olé soccer academy will not be liable for injuries sustained during these supervised activities.

By typing my name(parent or guardian), I fully understand and agree with the waiver information. *
Time slot(select only 2 sessions per athlete)                $55 for additional session *
Required
By checking the box I agree that they payment of $150 and/or if an extra session added will be fully paid by cash or check before the program begins(a $50 late fee will apply) *
Required
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