Trial Class Registration Form

Student Name *

First NameLast Name

Age*

Gender*

Mobile *

Emergency Contact #*

Location*

MONDAY 4-12 YEARS OLD WONG CHUK HANG RECREATION GROUND #108 WONG CHUK HANG ROAD 5PM - 6:30PMTUESDAY 4-12 YEARS OLD WONG CHUK HANG RECREATION GROUND #108 WONG CHUK HANG ROAD 5PM-6:30PMWEDNESDAY 9-12 YEARS OLD WONG CHUK HANG RECREATION GROUND #108 WONG CHUK HANG ROAD 5PM -6:30PMTHURSDAY 4-12 YEARS OLD WONG CHUK HANG RECREATION GROUND #108 WONG CHUK HANG ROAD 5PM -6:30PMFRIDAY 4-12 YEARS OLD WONG CHUK HANG RECREATION GROUND #108 WONG CHUK HANG ROAD 5PM -6:30PMMONDAY ACTIVE KINDERS 4PM-5PM WONG CHUK HANG RECREATION GROUND AGE GROUP 4-5YRS OLD

Preferred Date For Trial*

Date

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Ulimate Starz Football Academy. In exchange for the acceptance of said child’s candidacy by Ultimate Starz , I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Ultimate Starz and all its respective coaches and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected sessions.

In case of injury to said child, I hereby waive all claims against Ultimate Starz , 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.

Check the box if you Agree/or disagree*

I AgreeNo

Confirmation

BY AGREEING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

FREE TRIAL CLASS REGISTRATION FORM