GOALKEEPER COACHES COURSE APPLICATION

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FRIDAY AND SATURDAY MAY 24-25 2024

COMBO

COST $125 PER GOALKEEPER

(INCLUDES GK CLINIC AND KEEPER CHALLENGE)

INDIVIDUAL CLINIC

- GK COACHES COURSE/ GK CLINIC $75 PER PERSON

- KEEPER CHALLENGE $75 PER GOALKEEPER

EMAIL *

NAME *

TELENUMBER *

ARE YOU A COACH OR A GOALKEEPER PARENT? *

IM A COACH

IM A GOALKEEPER PARENT

IF COACH, WHAT IS YOUR CLUB OR TEAM NAME? *

AUTHORIZATION FOR EMERGENCY: I (named above), hereby, authorize the technical directors, other parents and / or mother of the team, and / or officers of International Cup USA/ KEEPER CHALLENGE to act as my agents in the capacity of supervisors of activities and drivers of vehicles. I also authorize each of them as well as contact the emergency named above to authorize an evaluation and / or medical, surgical or dental treatment.
I (parent or guardian) resign and otherwise agree to indemnify International Cup USA and Keeper Challange, its affiliated organizations and sponsors, trustees, owners, employees and associated personnel, including the owners of fields and facilities for the tournament, against and from any claim for or on behalf of the registrant. I hereby authorize participation in the tournament.

Option 1

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I HAVE READ THE EMERGENCY AUTHORIZATION, AND THE WAIVER, THE RISK ASSUMPTION AND WAIVER DOCUMENT, I UNDERSTAND THE CONDITIONS OF THE TERMS. I UNDERSTAND THAT I AND THE PLAYER HAVE RENOUNCED IMPORTANT RIGHTS BY SIGNING THIS FORM AND BY AGREEING WITH THESE TERMS. I SIGN THIS FORM FOR ME AND ON BEHALF OF THE PLAYER AND WE ACCEPT THESE CONDITIONS FREELY AND VOLUNTARILY AND WITHOUT PRESSURES OF ANY INDOLE.
*

I, Parent or guardian of the player above, I UNDERSTAND AND AGREE with the Medical Realse Form

In addition, I understand that the photo and / or image of my child may be used in the promotional materials of
International Cup USA/ Keeper Challenge on website/ Facebook or Instagram. By registering your child to play in the tournament, you authorize ICUP USA/ Keeper Challenge to use such images and videos without compensation.
*

I, Parent or Guardian of the player above, agree with social media photo and video release.

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