Winter Clinics Sign-Up Form
Please print this page, fill out the form completely and return it, along with a check payable to "In The Net" for the correct amount to the following address:
| In The Net Sports Academy |
| P.O. Box 1168 |
| Hollis, NH 03049 |
| *PLAYERS MUST SIGN-UP AGE APPROPRIATE |
| * ITNSA will try to honor requests, but will first match age and skill level to ensure a proper learning environment |
| Player's Name: ________________________ |
| Session Choice: 1 2 3 (circle one) Sport: _______________________ |
| Day / Time: ____________/__________ |
| Location (Derry / Tyngsboro / Milford) ________________ |
| Individual / Team / Goalie / Striker & Finishing / Speed and Strength / Adult Co-Ed Clinic: _____________ |
| Date of Birth: ____/____/________ |
| Address: __________________________ |
| City / State: _________________ / _______ |
| Zip Code: ____________ |
| Phone Number: _______________ |
| Email Address: _________________ |
| T-Shirt Size (S/M/L/XL) Youth ____or Adult _____ |
| Parent's Name: __________________________ |
| Emergency Contact's Name/Number: _______________ |
| Please circle: Soccer Ball $15.00 Size 4 / 5 or Lacrosse Ball $5.00 or Field Hockey Ball $5.00 Quantity ____ |
|
Coach Name: ____________________
|
| Coach Phone: ___________________ |
| Coach Email: ____________________ |
| .How did you learn about ITNSA? _____________________ |
| I, the parent/guardian of the registrant, understand and accept the condition that neither In The Net Sports Academy (ITNSA) nor anyone associated with ITNSA will assume any responsibility for accidents and medical or dental expenses incurred as a result of participation in an ITN program. I certify that the applicant is in good health and able to participate in the physical activity of a vigorous program. In the event of injury, ITNSA has my permission to obtain medical care. ITNSA may also use my child’s picture for promotional purposes. |
| __________________________ ______________ |
| Signed (Parent / Guardian) Date |