July 1, 2018 0 SUMMER WEEKDAY CLINICS DAYS: July 4th-August 22nd (8 weeks) DAYS: Wednesdays LOCATION: Belfield Recreation Center ADDRESS: 2100 Chew Ave, Philadelphia, PA 19138 AGES: Intermediate 7:00pm-8:00pm Advanced 8:00pm-9:00pm PRICE: $200 Player Name (required) Player Date of Birth (required) Player Age (required) Player Grade (required) Player's School Name (required) Guardian Name (required) Relation to Player (required) Guardian Email Address (required) Emergency Contact Name (required) Emergency Contact Number (required) Player Shirt Size (required) SmallMediumLargeXLarge I certify that I am the legal Parent/Guardian with legal responsibility for this participant, do consent and agree to his/her release provided above all releases, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the releases from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, Even if arising from their negligence, to the fullest extent permitted by law. As legal guardian of the above named participant, I assume all risks and hazards incidental to such participation including transportation to and from activities, and do hereby waive. release, absolve, indemnify, and agree to hold harmless the local league organization, league players, and the organizers, sponsors, supervisors, participants, and persons transporting the participants to and from activities (if applicable) from any claim arising out of injury to the participant. I give permission to managing personnel or other league officers or representatives, to authorize and obtain medical treatment from any licenses physician, hospital, or medical clinic, should the player become ill or injured while neither parent/legal guardian or emergency contact is available to certify. I hereby give permission to Probound, to photograph, film, videotape my child (above participant) to reproduce and publish said images for promotional/marketing purposes. By typing my initials in this box, I certify that all information on this form is accurate and truthful, and I adhere to all the above Click the button below to make a payment.