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Training Application Form - Please read the letter to parents before sending this application.

Complete and mail to:
Mr. Javier Rodriguez
73 Country Club Estates
Thornhurst, PA 18424
(570)472-3299

Name ________________________________________
Parents Name ________________________________________
Street Address ________________________________________
City/State/ZIP ________________________________________
Home Phone (____) __________________________________
_________ Male __________ Female
Age ________ D.O.B. _____/ ____/ _____

Important Insurance Information:

The parent or guardian of each player must sign the training registration form, granting permission to administer appropriate medical attention if necessary.

Preventative taping by the coaching staff will not be available during any training.

Wyoming Valley Sports Dome does not provide medical insurance for young people attending soccer training. Should hospitalization and/or the care of a physician be required, the player must rely on his/her medical insurance for payment of medical services.

Medical Insurance Information:

Company Name ________________________________________
Policy No.________________________________________

I approve my child's attendance at the Wyoming Valley Sports Dome and certify that he/she is in good health. If medical attention is required for illness or injury during training, I grant permission for medical attention if necessary. I hereby recognize and understand the Wyoming Valley Sports Dome, the coach Director and the coaching staff are not responsible for any injury of any kind that may occur on the way to, during, or on the way home from any training session sponsored by Wyoming Valley Sports Dome.

Signature________________________________________
Relationship________________________________________ Date ___/ ___/ ____