Parents must sign below prior to child’s participation 2022 Dominate the 18 Spring Goalkeeper Training. I hereby certify that the applicant is in good physical condition to participate in the 2022 Dominate the 18 Spring Goalkeeper Training. If medical assistance is required for illness or injury while attending the training, 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, 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 2022 Dominate the 18 Spring Goalkeeper Training. I hereby release Bob Pipech 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# *
