2023 DOMINATE the 18 Summer Goalkeeper Training Registration Form!  Monday through Friday 8:00 AM to 12 PM.  June 19th to 23th (5 days).  
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 June 2023.  If you do not wish for your child to follow these guidelines, we kindly ask that you do not sign up for this camp.

Camp will be held at the Plainfield Township Community Park in Kesslersville, PA. Cost is $355 with Gloves, $335 without glove until Feb 1st, 2023.  Prices increase by $10 after this date.  
 
Over 20 hours of Outstanding Goalkeeper Training!

All items must be completed to reserve your child's spot:
1) This registration form
2)  Payment: Going back to the main webpage and scroll to the middle of the page. You will see many convenient options there: https://www.dominatethe18goalkeepertraining.com/goalkeeping/summer-gk-camp-2023-pre-registration
3) Waiver (linked at the end of this form).  

If one of these items is not completed, the spot cannot be reserved.  Please make sure to complete all 3 items.  If you wish to verify or have any questions, please email dominatethe18soccertraining@gmail.com.

Weather is beyond the organizer's control. While every effort will be made to reschedule sessions missed due to inclement weather, this cannot be guaranteed.  

All Goalkeepers will receive a FREE DOMINATE the 18 Goalkeeper and Soccer Training Tshirt!   Goalkeepers who want a LIMITED Pair of DOMINATE the 18 Fingerprotective Gloves pay just $20 ($65 dollar value!). Players and families also have the option of enrolling in camp without purchasing gloves at the discounted $20 price.
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Email *
Cost. Early bird is $355 with Gloves, $335 without Gloves until Feb 1st, 2023. For all payments, please go back to the Summer GK 2023 main page, and scroll down to the middle of the page. You will see many convenient options there, including Paypal, Venmo, Credit or Debit, or Paypal pay Later (3% charge for electronic payment options). Please make sure that you select the proper OPTION desired (registration WITH or WITHOUT gloves) before selecting the payment method.    ***Please note that registration is not complete (Goalkeepers' spot not reserved) until payment is received.  *
Date of completion by Parent or Guardian *
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Name of Player (Participant) *
Age of Participant *
PLEASE SELECT YOUR CHILD's SIZE IF PURCHASING FINGERPROTECTIVE GLOVES AT A DISCOUNTED PRICE OF $20 ($65 Retail):                                Participant's Glove Size.  Please use this sizing info to help: https://docs.google.com/document/d/1XE5TcWSOJRsLF5iSoxSg5o8hVwahSZg_xvK9mvpF3xQ/edit?usp=sharing. Please note that size may be adjusted based on inventory and the best size for your goalkeeper.  Unfortunately, we do not have sizes under 7 (6 or below) or over 11 (12 or higher). It is recommended that you select the option without gloves if you need one of those sizes.  *
Name of Individual Completing this Form *
Relationship to Player (Participant) *
Date of birth (participant) *
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Gender of child *
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. *
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 2023 Dominate the 18 Summer Goalkeeper Training. I hereby certify that the applicant is in good physical condition to participate in the 2023 Dominate the 18 Summer Goalkeeper Training. 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, his associates, Plainfield Township, Northampton County, 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 2023 Dominate the 18 Summer Goalkeeper Training.  I hereby release Dominate the 18 Soccer, Bob Pipech and his staff, and all associated entitites 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 that you must go back to the main webpage, as a payment option will not automatically generate. Registrations without payment are not complete. *
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Waiver form, please go to: https://www.waiverfile.com/b/PipechElitelSoccerTraining/Waiver.aspx?formid=52394a22-40c2-4436-a564-1202854d9f28   After completing (keep this window open), please confirm below. *
A copy of your responses will be emailed to the address you provided.
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