Sunday, May 7, 2023 from 5:45 PM to 6:45 PM PDT
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Placer United Soccer Indoor Training Center

1091 Tinker Road, Suite 300
Rocklin, CA 95765

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Coach Kevin Unsworth
Placer United Soccer Club

Munchkin Madness - May 7 - 8-10 year olds

Join the professional coaches from Placer United Soccer Club for Munchkin Madness, a fun soccer clinic specifically for children ages 5-10. Clinics will include a variety of fun games and disguised learning, working on soccer skills such as dribbling, passing, ball control, and shooting.

* Required information

Player Information

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    Grade (this year):

Siblings Information

You may add a maximum of 3

Parent/Guardian Information

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Emergency Information

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  • This form must be acknowledged for each soccer player (participant) and, if the player is under 18-years old, must be acknowledged by the player’s parent or legal guardian. No player will be allowed to participate in soccer games without this form, properly executed, and on file.

  • Soccer is a physical, contact, sport that involves the risk of injury. I assume all risks and hazards associated with my player's participation in the sport. My player is in proper physical condition to participate in soccer practices, games, clinics, or soccer-related events; and has no illness, disease, existing injury, or physical defect that would be aggravated by participation. I will inform the coach or the event coordinator if this status changes. I further acknowledge that this risk may involve loss or damage to my player or my property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care. I have a current medical consent form in force. My player will wear shin guards, properly-fitted and appropriate shoes, and other protective equipment (e.g., mouth-pieces), as provided by soccer rules, to all events.

  • The club, league or tournament does not have personal injury insurance that covers my player’s participation. Therefore, I should have a current, active, personal injury insurance policy in force, which covers my player’s participation. Under any condition, I am responsible for any and all medical expenses arising from my player’s participation, both in practices and games and while traveling to and from these events. I have the right and responsibility to inspect the equipment and facilities prior to events and, if I believe that anything may be unsafe, I will advise the coach or supervisor of the condition and may refuse to allow my player to participate. Participation assumes consent. I authorize my player’s photograph, picture or likeness, and voice to appear in any documentary, promotion (including advertising), television, video, or radio coverage of the Club, league, tournament, or event – without compensation.

  • I hereby release, waive liability, discharge, hold harmless, indemnify, and covenant not to sue, the United States Soccer Federation, the State Association, the Club, the league and tournament, their associated directors, administrators, officers, managers, employees, coaches, trainers, volunteers, sponsors and advertisers, and other agents, estates or executors, from any and all liability incurred in the conduct of, and my player’s participation in, their soccer programs. This includes owners, lessors, and lessees of premises, municipalities, government agencies, successors, heirs, and assigns. I have completely read this document and fully understand its contents. I acknowledge that I have given up substantial rights by accepting this document and that I do so voluntarily and attest to this on behalf of myself and my executors, personal representatives, administrators, heirs, next-of-kin, successors, and assigns.

  • As the parent and natural guardian or legal guardian of the participating player, I hereby agree to the foregoing Waiver of Liability and Release for, and on behalf of, the participant (player/minor) named. I hereby bind myself, the minor, and all other assigns to the terms of the Waiver of Liability and Release. I represent and certify that I have the legal capacity and the authority to act for, and on behalf of, the minor in the execution of this Waiver of Liability and Release.

  • Visual Consent - I give Placer United Soccer Club and any photographer hired by them, permission to make photographs, videotapes, films, slideshows, or other likenesses of my child or legal ward. I hereby grant Placer United Soccer Club and any photographer hired by them, the unrestricted right to copyright any of the above-mentioned materials containing images of me, my child or legal ward, as well as the unrestricted right to use and reuse them, with or without caption information, in part or in whole, in any manor, for any purpose and in any medium now known of hereinafter invented. These rights include, but are not limited to, the right to publish copy, distribute, alter, license and publicly display these materials and images for editorial, trade, marketing and/or advertising purposes. I also grant Placer United Soccer Club and any photographer hired by them, and its licensees the unrestricted right to use and disclose my name in connection with the use of the above materials.

  • I understand and I agree I will not be paid for any of the described above. I also waive, and release and discharge, Placer United Soccer Club and any photographer hired by them, any and all claims arising out of or in connection with any use of the materials, caption information and images above, including any and all claims for libel, defamation and/or invasion of privacy or publicity. I realize I cannot withdraw my consent after I sign this form and I realize this form is binding on me and my heirs, legal representatives and assigns.

  • Do you agree to the waiver?


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