Player's Name *

First Name

Last Name

Player's Date of Birth *

MM

DD

YYYY

Player's Personal Phone

***Leave blank if the player doesn't have a personal phone. Parent/Guardian Information will be asked on the following section.

(###)

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Player or Family Primary Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Parent/Guardian's Name *

First Name

Last Name

Primary Parent/Guardian's Phone *

(###)

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Secondary Parent/Guardian's Name

First Name

Last Name

Secondary Parent/Guardian's Phone

(###)

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Understanding & Assumption of Risk Agreement *

ASSUMPTION OF INHERENT RISKS: By checking this box I understand that the inherent risks of recreational/competitive sports activities, including conditioning and training for competition, vary with the activity, the muscle group involved, and with the equipment used. Common minor risks include, but are not limited to, property damage, minor muscle strains, muscle sprains, muscular fatigue, cuts, bruising, being struck by moving objects or fellow players, and post-exercise soreness. More serious risks include, but are not limited to, joint injuries, torn muscles, heat-related illnesses, eye injuries, broken bones, and back injuries. There is also the more remote risk of a catastrophic incident, for example, stroke, heart attack, paralysis, or death. I understand the types of injuries that may occur as a result of participating in Sports Activities. I hereby assert that my participation in any of Po'ohala Venture's Soccer Program (Po'ohala Futbol Club) camps or activities is voluntary and that I knowingly assume all inherent risks of the activity.

COVID-19 Safety Rules & Regulations Agreement *

By checking this box I confirm that I have read all safety rules and regulations set forth for the Po'ohala Futbol Club Program during the COVID-19 pandemic, and I hereby accept and agree to follow all rules, regulations, and procedures in order to provide as safe of an environment as we can for program participants. I further understand that Po'ohala Ventures and any of its staff volunteers reserve the right to send home any participant not abiding by these rules, regulations, and procedures.