UPDATED PGK FREE GK Sessions

Goalkeeper's Name*

First NameLast Name

Date of Birth *

Date

Goalkeeper Age*

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email*

example@example.com

Parent/Guardian Cell*

Please enter a valid phone number.

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current Club Team*

CERTIFICATION OF PHYSICAL FITNESS TO PARTICIPATE:

1. I understand that there is a risk in participating in any sport, including Performance Goalkeeping sessions, a risk of injury, including but not limited to serious permanent injury, paralysis, and death. To minimize the risk of injury, I agree to tell my child to obey all safety rules and to report fully any problems related to his/her physical condition to the PGK coaches as soon as the problem begins.

2. By signing below, I certify the following:

• That my child is not currently under the care of a physician for an injury or illness that would prevent his/her safe participation in PGK session.

• That my child is not currently being treated for or recovering from an orthopedic injury that would prevent his/her safe participation in a PGK session.

• That my child has no history of fainting or other problems related to strenuous exercise.

• That my child is in good health and there is no reason he or she cannot safely participate in strenuous physical activity.

CONSENTS:

1. By my signature below, I hereby give permission for the Performance Goalkeeping and it’s employees and agents to obtain medical treatment for my child in the event of accident or illness during his/her time at a PGK session.

2. By my signature below, I hereby give consent to have my child be photographed or videoed during PGK activities, and I agree that the images so obtained may be used for educational and public relations purposes by Performance Goalkeeping LLC.

RELEASE:

1. I do hereby agree that I am and shall be responsible for all costs associated with any injury or loss that maybe sustained by my child as a result of his or her participation at Performance Goalkeeping. I also certify that I have health insurance that provides adequate coverage for injuries or illness my child may sustain while participating at Performance Goalkeeping LLC.

2. By my signature below, I also agree to release and promise not to sue Performance Goalkeeping LLC, or their employees or agents, for any damages, loss, injury, or death arising from my child's participation in the Performance Goalkeeping Sessions.

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Signature *

PGK FREE GK Session - MUST SIGN UP FOR YOUR BIRTH YEAR SESSION*

Birth years 2017 to 2015 – Nov 16th 6:00pm-7:15pmBirth years 2014 to 2007 – Nov 16th 8:00pm-9:15pm

Donation Amount

USDIf you would like to donate to PGK for the running of the GK sessions, thank you! But not needed to attend.

Payment Methods

Credit Card

Apple Pay

Google Pay