Individual Activity Registration

Kids America Activities

Registration Fee

Signature                                                                                                               Date

Name                                                                                           Age                   Birthday

Address

Phone                                                                                           Other Phone

Waiver Statement (Must Be Signed to Participate)

I recognize that injury may be sustained because of the potentially hazardous nature of this activity.  In the event of such injury to myself or my child, if or when my spouse or I cannot be contacted I give permission to the attending physician to render treatment as would be normal, and I agree to pay the usual charge for such treatment.  I agree to abide by all facility and equipment rules, regulations, and standards of conduct.  I also understand that Kids America, Inc. reserves the right to remove patrons who do not obey the rules, regulations, and standards of conduct.  I now release Kids America, Inc., its employees, agents, and assigns from any and all claims, causes of action suits, and related rights for himself/herself, his/her estate, his/her heirs; administrators, executors, etc. for any and all injuries, illnesses, and damages sustained as a result of participation at Kids America, Inc.  This release applies to any present or future injuries and it binds my heirs, executors, and administrators.  I understand that participants may be videotaped or photographed during this activity.  I release the rights of those video tapes and photographs to Kids America.  I have read this release and all of its terms.  I sign it voluntarily and with full knowledge of its significance.  This agreement shall become effective as the date signed below and will remain in force and in effect for one full year.

Parent / Guardian                                             Would you be interested in being a Coach or Team Mom?

City                                                                                               State                 Zip

Method of Payment:

Youth T-Shirt Sizes:    Small (6-8)    Medium (10-12)    Large (14-16) 

Adult T-Shirt Sizes:    Small     Medium     Large     XL     XXL     XXXL

KA Soccer Academy (Fall Session)
August 21 to October 2     $50.00
 (Ages 7 - 10 Years Old)

Shorties Soccer is a great way to introduce your child to soccer in a low pressure activity that builds social skills, soccer skills, and coordination.  The fall session will be run by Isaac Bush and the Kids America Staff.  It will involve one practice a week.  Games will be on Saturday mornings from 10am to 1pm.  Shorties Soccer starts with an Orientation on August 14 at 10a.m. For more information contact Isaac Bush by phone at 622-6657 or by e-mail at isaac@kids-america.org.

Outdoor Shorties Soccer (Fall Session)
August 21 to October 2 $40.00
(Ages 3 - 6 Years Old)

KA Soccer Academy is open to players ages 7-10 years old.  The League will start with an orientation on August 14 at 9a.m.  Games will start on August 21, 2010 and will be played on Saturdays at 9am. Practices will be on Tuesdays from 5pm to 6pm.  Practice will concentrate on developing foot-skills and techniques that will help the players transition to playing team oriented soccer.  Players will participate in conditioning, agility, and speed skills training. Training sessions and games will be run by Isaac Bush and the Kids America Staff.  For more information about KA Soccer Academy contact Isaac Bush at 740-622-6657 or by e-mail at isaac@kids-america.org.

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