2016 Futsal Clinic Registration

**Scroll down for the 2016 Futsal Indoor Soccer Clinic registration form**

BRAZILIAN INDOOR FUTSAL SOCCER CLINIC

Instruction by Fraga DaRosa, former 10 yr Brazil Pro Player

When: Fridays, October 21, 2016 & Nov 18, 2016

Where: Briarwood Presbyterian Church Gym

Ages: 7-10 at 5:30-6:45pm, 11-14 at 6:45-8:00pm

Fee: $25 per player per session, $20 for each additional family member.
Please mail check or money order to Briarwood Soccer Club,
2200 Briarwood Way, Birmingham, AL 35243.
You can also bring your payment to the Quest office
room G100 at Briarwood Church.

WHAT WILL YOUR PLAYER LEARN? FUTSAL...a high energy fun Indoor soccer style, great skill developer, creates precise ball control, tech skills, decision making, team approach, improve outdoor game, quick passes and receiving, agility, accuracy, playing calm under pressure, passion for the sport, POSITIVITY!! Visit us at FRAGA ELITE SOCCER on FB!!

Space is limited to 18 players per session!

2016 Futsal IndoorSoccer Clinic Registration Form:

* Indicates required field

Which futsal session are you attending? *

Child's Name: *

First

Last

Age: *

Date of Birth: *

Address: *

Line 1

Line 2

City

State

Zip Code

Country

Health Issues (if any): *

Parent(s) Name(s): *

Email *

Primary Phone Number: *

Mother's Cell: *

Father's Cell: *

What church (if any) do you attend? *

What school does your child attend? *

What grade will your child be entering in Fall 2016? *

What Fall 2016 or Spring 2015 team did you play for (i.e. Briarwood Soccer U10, Coach Leib): *

CONSENT STATEMENT: I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Briarwood Soccer Club (BSC) and its affiliates. Recognizing the possibility of physical injury associated with soccer and in consideration for BSC accepting the registrant for its soccer programs and activities (The Programs), I release, discharge, and/or otherwise indemnify BSC, its affiliates, other employees and associated personnel, including the owners of the fields and facilities used for the Programs, against any claim by or on the behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I authorize. I give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions necessary to preserve the well being of my dependent.

By typing your full name and the date, you (the parent/guardian) agree to the above statement and verify that the information given is correct to the best of your knowledge: *

** YOUR SPOT IS NOT CONFIRMED UNTIL PAYMENT IS RECEIVED **

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