Player Name *

First Name

Last Name

Phone

(###)

###

####

You agree that Baller Soccer may capture photo/video content to help player make technique corrections as well as to use for social media and other marketing *

Yes

You are comfortable with Baller Soccer trainers making professional hands-on corrections for player technique (for example; correcting foot position striking ball) or physical contact during game related activities and drills *

Yes

No

You agree that to the best of your knowledge your player is physically cleared to participate in contact sports like soccer and understand the risk of serious injury and release the instructor and accept all liability for any damage/loss *

Yes

Please enter your full name *

First Name

Last Name

By checking here, you agree the above is your electronic signature and you are the legal parent/guardian of the above player

Yes