Dutch Masters Soccer Academy REGISTRATION


Player's Name: Age/League (i.e. U-12 Boys):
Division Level (circle one) RECREATIONAL SELECT/PREMIER
Parents Name: Home Phone:
Address: Work Phone:
City: State: Zip:
Email Address: Primary Color of team:
Special Scheduling Request (no guarantee):
Cost: $95 per indvidual
MC/VISA #: CHECK:
EXP: AMOUNT:$

WAIVER/EXCLUSION CLAUSE (ALL INDIVIDUAL SIGN UPS MUST COMPLETE)

I, the undersigned on behalf of himself or herself, or as parent of guardian in enrolling at the Soccer Stop, understand that in attending any sports program and using the facilities does so at participants own risk. The Soccer Stop, its owners, employees, and agents, not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant and family on premises. Participant parents and guardians assume full responsibility for all injuries and damage which may occur in or about programs on the premises and does hereby fully and forever release, discharge, and hold harmless the Soccer Stop, its owners, employees and agents from any and all claims, demands, rights of action, present or future resulting from or arising out of any person’s participation in any programs or use of its facilities. In addition, participant agrees to follow the rules and conduct as set the Soccer Stop. I, the undersigned parent/guardian/participant of age do hereby grant authority the staff of the Soccer Stop to render judgment concerning medical assistance to hospital care in the event of an accident or illness during my absence.

Signed: Dated:


5 River Hills Drive Holland, Mi 49424 Phone: 616.393.7768 Fax 616.393.7762 Email: soccerstop@tds.net