Successful Goalkeeper training for ALL ages!
( 9 4 9 ) 2 5 7 - 8 4 7 2
info@shotstoppersga.com
WAIVER OF LIABILITY:
*Players without signed Release forms may not participate.
Release of liability:
On behalf of the named applicant(s) __________________________________, I release Shot Stoppers Goalkeeping Academy and its’ employee’s from claims arising from participation in this program. Neither Shot Stoppers Goalkeeping Academy, Johann Noetzel, or anyone connected with Shot Stoppers Goalkeeping Academy assumes any responsibility for accidents, medical, dental, or any other expense incurred as a result of this program. I accept full responsibility for any medical problems that may develop as a result of any activities in this program.
Full Name/Print:______________________________________________
Signature:___________________________________________________
(Applicant or Parent/Guardian)
Emergency Contact:__________________________________________
Relationship:________________________________
Phone:( )____________________________
Media release:
I understand that photos/videos taken at training sessions by Shot Stoppers GK Academy staff, or by professional photographers contracted with Shot Stoppers GK Academy, may be used for the sole purpose of promoting Shot Stoppers on it’s proprietary website (shotstoppersga.com), or in promotional material such as flyers and post cards. All photos taken will be available to participants, fees may apply. By signing this release I consent to have my photo/or my dependant’s photo used in S.S.G.A. promotional material.
Name:(Print)________________________________________________
Signature: _________________________________________________
Date: / / 10
