Easterseals of SEPA

By signing and submitting this form, you confirm you are over the age of 18 and are providing consent for the collection of this information on behalf of a child under the age of 13. Personal information will be used solely for registration and communication related to the Soccer for All Clinic and will not be shared or sold.  I, the parent/guardian of the above-named child, understand that participation in soccer involves physical activity and risk. I release and hold harmless organizers, coaches, and facility from any and all liability arising from participation. I certify the above-named child is in good health and able to participate. I grant permission for photos/videos of my child to be used for promotional purposes.