TFC Goalkeeper Camp- June 22-24, 2021

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:
• * T-Shirt Size --Choose-- Youth - XS Youth - S Youth - M Youth - L Youth - XL Adult - S Adult - M Adult - L Adult - XL Adult - XXL
• * Gender --Choose-- Male Female
• * Date of Birth/Age

• Fee

  Type	Fee
  Event fee	$125.00
  Event fee type 2	No Charge

Parent 2

• First Name
• Last Name
• Home Phone
• Work Phone
• Cell Phone
• Cell Phone Carrier
• Email

Business Information

• *

  Is your child covered by insurance

  • Yes
  • No
• *

  We the parents of the above child, hereby give approval for their participation in any and all activities connected with the above program. I/We assume all risks and hazards incidental to the conduct of the activity, and transportation to and from the activities and we do further hereby release and hold harmless the TPRD, Tupelo Advisory Board, the City of Tupelo, the sponsors, the supervisors or all them from any and claims of injury or claims arising from participation in the above acivities.

  • Yes I agree
  • No I do not agree
• *

  In case of injury to my child, I/We likewise waive all claims for damages that we might have against the above mentioned and likewise waive any claim against any person transporting my/our child to or from activities.

  • Yes I agree
  • No I do not agree

Signature

• Please sign Name

Sibling Information

You may add a maximum of 2