Warriors Soccer Clinic 2019
This pre-season clinic is intended for any girl entering the 3rd through 8th grade this fall. The program will run daily (Monday, August 19; Tuesday, August 20; Wednesday, August 21) from 9:00am-11:30am at the LSRHS turf field. The program will be run by returning varsity players and overseen by a member of the LSRHS Girls Soccer Program coaching staff. The cost of the clinic is $120 per clinic participant. Registration is complete once you have completed this form and the $120 registration fee has been made to LSRHS Girls Soccer and received by Coach Grant: LSRHS Girls Soccer, c/o Coach Grant, 390 Lincoln Road,  Sudbury, MA 01776. Please e-mail lsgirlssoccer@gmail.com if you have any questions. Thank you and we hope to see you at our clinic in August! And, please FOLLOW US on Instagram @lsvgsofficial!!! :)
~ LSRHS Varsity Girls Soccer

By completing this form, you (a legal parent/guardian of the clinic participant named below) recognize: (1) There are risks of injury or damage resulting from such participation. Any activity involving contact, motion or height creates the possibility of serious injury, including permanent paralysis and even death; (2) There may be costs in the event of such injury or damage and all costs, for the injury or damage and for any insurance against such risks, are the responsibility of the undersigned.

In the event of an injury requiring more than basic first aid, it remains the responsibility of the parent/guardian to make arrangements for medical care and transportation of his/her child. The clinic will make every reasonable effort to contact the parent/guardian in the event of such injury and provide an adult to accompany the injured athlete.

Emergency information is based on the contact information you provide below.  You should also notify your physician that he/she is authorized to render care in the event that you cannot be contacted. An ambulance will transport clinic participants with serious injuries to the nearest hospital. The emergency room will not treat your child (except for life threatening injuries) unless a parent/guardian or personal physician gives injury specific approval.
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By clicking the following checkbox, I am granting permission for my daughter (the clinic participant, named in the fields below) to participate in the 2019 Warriors Soccer Clinic as it has been described above. *
Required
Please provide, as an e-signature for the above, your full legal name. *
name of parent/guardian
Parent/Guardian Email *
Parent/Guardian Primary Phone # *
FIRST Name (of the clinic participant) *
first name only
Preferred Name (nickname of the clinic participant)
LAST Name (of the clinic participant) *
last name only
Grade (as of 9/1/2019) *
(this is information about the clinic participant)
Street Address *
City/State *
Zip Code *
Full Name (First and Last) of Emergency Contact #1 *
Relationship (to clinic participant) *
of emergency contact #1
Primary Phone # *
of emergency contact #1
Secondary Phone #
of emergency contact #1
Email *
of emergency contact #1
Full Name (First and Last) of Emergency Contact #2
Relationship (to clinic participant)
of emergency contact #2
Primary Phone #
of emergency contact #2
Secondary Phone #
of emergency contact #2
Email
of emergency contact #2
Insurance Provider *
Policy Number *
Physician Name *
Physician Phone # *
Allergies
Existing Medical Conditions
Current Medications
Other Information
Photo/Video Release: Permission is hereby given for the Warriors Soccer Clinic to use any images (digital, photographic, video and audio) or likenesses of my daughter (the clinic participant) in promoting the Warriors Soccer Clinic and in other ventures or media directly relating to the Warriors Soccer Clinic. *
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