Dominate the 18 Goalkeeper Mentoring Program!

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Complete this form to enroll in the Dominate the 18 Mentoring Program. This is an outstanding program that we take great pride in to provide support to Goalkeepers. The Mentoring Program includes:

2 30-min Virtual Meeting sessions per month (parent present for 15 and under)
Ability to email us with direct goalkeeping or situational questions (will get back to you no later than 48 hours, usually 24!)
We will come to one of your matches to watch you play (30 mile radius from Allentown, PA)! You can also share game footage online.
Discount on future training opportunities
Swag for year-long members! And More!!! Additions will be added to enhance the program!
Sign up today!

**Subject to change. Dominate the 18 Goalkeeper and Soccer Training and Bob Pipech reserve the right to modify this program to enhance the program, or for the safety and protection of participants and staff

Email *

Cost: $19.99 per month, or $99.99 for 6 months. Unless you use the Paypal payment button on the website, you must manually enter the payment amount. *

Paypal (preferred) please go to: paypal.me/Dominatethe18 OR please use the Paypal link on the Mentoring Program page

Venmo @GKdominatethe18 or click on the image below and scan the QR code

If paying by check, please email dominatethe18soccertraining@gmail.com to ask for the mailing address

I used the Paypal link on the GK Mentoring Program Webpage: https://www.dominatethe18goalkeepertraining.com/mentoring-program. I

Date of completion by Parent or Guardian *

YYYY

Name of Player (Participant) *

Age of Participant *

Name of Individual Completing this Form *

Relationship to Player (Participant) *

Date of birth (participant) *

YYYY

Gender of child *

Female

Male

Other

Perfer not to answer

Mailing address *

City, State, Zip *

Current Soccer Club *

Phone #1 (primary contact) *

Phone #2

Email: *

Emergency Contact *

Parents must sign below prior to child’s participation in the Dominate the 18 Goalkeeper and Soccer Training Mentoring Program. I hereby release any and all liability as a result of communication between Dominate the 18 Goalkeeper and Soccer Training and my child. I hereby agree to attend all meetings held virtually with my child (ages 18 and younger). *

Confirmation that payment was made. Please note that if you completed this registration form, but did not complete payment, your child's place cannot be reserved until payment is complete. The program usually sells out quickly. If you did not use the Paypal buttons in the middle of the GK Winter webpage for payment, you must manually enter the amount ($19.99 or $99.99) on the platform used. *

Yes, I completed payment!

No, I will do right after completing this form.

Waiver form, please go to: https://www.waiverfile.com/b/PipechElitelSoccerTraining/Waiver.aspx?formid=71be491a-aa5e-4b7b-a07f-29597fe65c6c. After completing (keep this window open), please confirm below. *

Yes, I have completed the waiver form

No, please go to https://www.waiverfile.com/b/PipechElitelSoccerTraining/Waiver.aspx?formid=9eb89e59-f416-42cf-b858-68265dcf801c before preceding

Other:

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