DOMINATE the 18 Individual/Small Group Field Player Training 2024
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.

This form is good for 6 months from the date of completion. It must be re-completed after 6 months in the event any information changed or has been updated.
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Email *
Date of completion by Parent or Guardian *
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Name of Player (Participant) *
Age of Participant *
Name of Individual Completing this Form *
Relationship to Player (Participant) *
Main or Favorite Position of Player *
Areas the player wants to work on/develop.  We will also speak with the player, and design training to enhance other areas and develop a comprehensive and dynamic player *
Cost $80 per 1-hr session. For single sessions, payment can be made prior to or directly after the conclusion of the session.  If you are signing up for a 6-session package, the cost is $420.  6-session packages are good for 6 months after the date of completion of this form, and must be paid for in advance prior to the first session.  Regardless of the training method, the payment options in the middle of the individual/small group Field Player webpage allow you to select the proper option from the drop down menu, then pay using one of the convenient payment methods.  There are other options below, but the amount must be manually entered. *
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 in individual/small group training. *
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 2024 Dominate the 18 Individual/Small Group Training. I hereby certify that the applicant is in good physical condition to participate in the 2024 Dominate the 18 Dominate the 18 Individual/Small Group Training. If medical assistance is required for illness or injury while participating, I give permission for such care and I certify I have medical insurance, and that the applicant is covered by our family medical insurance. Dominate the 18 Goalkeeper and Soccer Training, their associates, Plainfield Township, Hanover Township, Forks 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 2024. Dominate the 18 Individual/Small Group Training. I hereby release Dominate the 18 Soccer and Goalkeeper Training and his 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# *
Waiver form, please go to:  https://www.waiverfile.com/b/PipechElitelSoccerTraining/Waiver.aspx?formid=4b01bef7-b374-4fed-9bff-994e537e6192. 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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