Finishing Clinic (September 2nd)Please enable JavaScript in your browser to complete this form.Child Name: *FirstLastEmail *Has Your Child Trained With Fussbally Before? *YesNoParent Name: *FirstLastBirthday of Child: *Prior Soccer Experience of Child: *Payment: *Sign Up - $72.00Clinic is for levels 2-8Would you like to add a second Child?YesNoChild 2 Name: *FirstLastHas Your Child Trained With Fussbally Before? (Child 2) *YesNoBirthday of Child 2: *Prior Soccer Experience of Child 2: *Payment: *Sign Up - $72.00Clinic is for levels 2-8Emergency contact: *Informed Consent and Acknowledgement * *I AgreeI hereby give my approval for my child’s participation in any and all activities prepared during the selected camp. In exchange for the acceptance of said child’s candidacy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Rachellasse Limited and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Rachellasse Limited, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death. We sometimes take photographs or video footage for publicity purposes. These images may appear in our printed publications and publicity materials, on our website, or both. We may also send the images to the news media, who may use them in printed publications and on their website, and store them in their archive. They may also syndicate the photos to other media for possible use, either in printed publications, or on websites, or both. When we submit photographs and information to the media, we have no control over when, where, if, or how they will be used. I hereby give my approval for my child to potentially be filmed while participating in the Camp. Medical Release and Authorization * *I AgreeAs Parent and/or Guardian of the named Child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Rachellasse Limited and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence. Cancelation and Payment Processing Fee *I understand - $0.00Fussbally Camp Cancellation policy: Until 60 days before camp starts: 80% refund Until 30 days before camp starts 50% refund Up to 14 days before camp starts 100% transfer of credit towards other trainings (members only) 14 or less days NO refund I understand that the processing fee of 3% is only to cover Stripe / Paypal Fees. MEMBERS CAN WORK AROUND THIS FEE BY PAYING WITH ZELLE. To do that simply Zelle us the price of the camp + send us a short text with all we need to know. Zelle: Rachellasse Limited Phone: 303-828-7079 Zelle: Rachellasse Limited Phone: 303-828-7079 Stripe Credit Card *CardName on CardTotal: $0.00Submit