GK SUMMER PROGRAM REGISTRATION:

One step away from being the goalkeeper you dream of!

SESSIONS

SESSION 1: Morning DUBLIN July 6 - July 10 9:30AM- 12:00PM$550

SESSION 1: Evening HILLIARD July 6 - July 10 6:00PM- 8:30PM$550

SESSION 2: Morning DUBLIN July 13 - July 17 9:30AM- 12:00PM$550

SSESSION 2: Evening LEWIS CENTER July 13 - July 17 6:00 PM - 8:30PM$550

SESSION 1 AM & 2 Dublin and Hilliard$1,000

SESSION 1 PM and 2 Dublin and Lewis Center$1,000

NOT AVAILABLE: High School GK 4 Day Camp June 30-July 3 9:30AM-12:00PM Dublin $400

Student's First Name

Student's Last name

Gender

Female

Male

Date

Month

Day

Year

Age

Address

Phone

Emergency Contact

Parents' Names

T-shirt size

Gloves size

PARENT / GUARDIAN: CONSENT AND WAIVER

I hereby represent that the information provided in the registration process is true and accurate. The named applicant is in good health and has my permission to participate in Geosas Goalkeeper Academy Program/Activity. I acknowledge that soccer is a contact sport and that there is a risk of injury from participating in the competition. I HEREBY WAIVE AND RELEASE Geosas Goalkeeper Academy and its agents, servants and employees from any liability and claims for damage. IN the event of an emergency, I hereby grant permission to such medical personnel as necessary to render treatment.

Parent Signature

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