Lancaster Goalkeeper Wars Waiver and Release Form Please enable JavaScript in your browser to complete this form.ATHLETE INFORMATIONIf you have more than one athlete, please fill out a seperate form and use unique emails for each. I am filling this form to learn more about/register for *Goalkeeper warsRegular Goalkeeper TrainingRegular Field Player TrainingChoose all that applyAthlete's Name *FirstLastNickname (OPTIONAL)Date of Birth *MM/DD/YYYYAthlete's Sex *MaleFemaleIn what category will your Goalkeeper be participating in? * U8-U11U12-U14U15-18Medical Information/Allergies *Write none if not availableHealth Insurance Provider *Write none if not availableWhat is the athlete's shirt size? *YouthAdultYOUTH T-Shirt Size *Y-SmallY-Medium Y-LargeAdditional t-shirts can be purchased at request.Adult T-Shirt Size *SmallMedium LargeX-Large2X-LargeAdditional t-shirts can be purchased at requestCONTACT INFORMATION*If U18 (Parent or Guardian Information) 1 Parent/Guardian's Name *FirstLast1 Relationship to Athlete *Primary Cell Phone *Number coaches can use for feedback, questions, and practice cancelations. Can we text you? *YesNoPrimary Email *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSecond Parent/Guardian (Optional)I would like to add another parent/guardian? *YesNo2 Parent/Guardian's Name *FirstLast2 Relationship to Athlete *2 Phone *555-555-5555EMERGENCY INFORMATIONEmergency Contact's Name *FirstLastRelationship to Athlete *Phone *WaiversPlease read the following statements, if you have read and accepted all the terms and conditions of Diamante Soccer Academy LLC's Lancaster Goalkeeper Wars, check "YES" and sign below. Consent Agreement *YESI, the minor's parent and/or legal guardian, understand the nature of soccer activities and the minor's experience and capabilities and believe the minor to be qualified, in good heath, and in proper physical condition to participate in such activity. I hereby release, discharge covenant not to sue, and gree to indemnify and save and hold harmless each of the realasee's from all liability claims, demand, losses, or damages or thEmergency Treatment Release. *YESPERMISSION IS HEREBY GRANTED TO DIAMANTE SOCCER ACADEMY LLC., and its affiliates including Trainers, Directors, Coaches, and Team Parents to who have the proper training to provide the needed emergency treatment before the athelete's admission to the medical facility. Medical Release and Authorization *YESI, Parent/Guardian, hereby authorize in my absence or unconsciousness the diagnosis and treatment by a qualified and licensed medical professional, of the athlete, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the athlete's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Media Release and Confirmation *YESI, Parent/Guardian of said athlete, grant permission to Diamante Soccer Academy LLC (DSA). Diamante Goalkeeper Academy (DGK), and Lancaster Goalkeeper Wars (LGW) and its agents and emplyeees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, recruitment, website, social media, and other forms of marketing and in any medium. I hereby release DSA, DGK, and LGW and its legal representatives for all claims and liability relating to said image or video. I waive my right to any compensation. Please add me to your Quarterly Newsletters and keep me updated on future events, and camps. *YesNoQuestions can be directed to Coach Josue Bosque at DGKSoccerAcademy@gmail.com.Complete Intake