Goals for Girls Clinic Registration (Please Complete One Form per Player) Sponsored by: Player’s Name ______Age______T-shirt: - size: Youth______Adult______Order an extra T-shirt - size: Youth______Adult______Email______Address______Phone Number ______Team Name______Parent/Guardian Name______Emergency Contact ______Phone Number______Any Known Allergies/Medical Conditions ______Soccer Clinic with Olympian and VOLUNTARY WAIVER AND HOLD HARMLESS U.S. Women’s National AGREEMENT/ CONSENT TO MEDICAL TREATMENT

Cut and mail in withcheck I, the above named Parent or Guardian, authorize the above named Minor Team Players Child, to attend the Goals for Girls soccer clinic in and to take part in all activities and programs. I understand that the Goals for Girls soccer clinic activities are inherently dangerous, including without limitation a physically demanding regimen in sometimes adverse weather conditions. We (i.e., Parent/Guardian and Minor Child) individually, expressly and voluntarily, assume the risk of any and all injury or damage to Minor Child, including but not limited to death, or loss of or to Minor Child’s property which may arise in connection with, or as a result of, the Goals for Girls soccer clinic. To the best of our knowledge, Minor Child is in good physical condition and we are not aware of any physical infirmity which would place Minor Child at risk to participate in any way in strenuous physical activities. We individually and voluntarily assume full responsibility for any risk of loss, property damage or personal injury, including death, that may be sustained by Minor Child as a result of being engaged in Clinic activities, whether caused by the negligence Train with: of the Goals for Girls soccer clinic, its affiliates, employees, officers, directors, agents (collectively, “Releases”) or otherwise. We further hereby individually agree to indemnify and hold harmless the Releases from any loss, liability, damage or cost, including court costs and attorney’s fees, that may accrue related to Minor Child’s participation in the Goals for Girls soccer clinic, whether caused by the negligence of Releases or otherwise. During the period of the Clinic, we hereby individually give permission to the Clinic staff to administer first aid and/or to authorize medical treatment or surgical care for Minor Child if an emergency situation should arise. We understand that a Cindy Parlow conscious effort will be made to locate a Parent or Guardian in such an event. We also understand that we individually accept full responsibility for payment of any and all medical expenses, whether or not authorized by us. In signing this agreement, we individually acknowledge and represent that we have read and understand it and sign it voluntarily.

More info about Goals for Girls Facebook www.facebook.com/goalsforgirls ______Parent/Guardian Signature Date Website http://www.goalsforgirls.org/ Open to girls age 5- To Register: 15 years of age 1) Complete this registration form (see reverse side) 2) Write check to DC Soccer; Please bring your write Goals for Girls on memo soccer ball and line water 3) Mail check and registration form to:

Space is Limited so Goals for Girls Register Early!!! c/o Sara Callow When: Saturday May 24 from 262 Pinehurst Ave 9am-12noon (check-in at 8:45am) Los Gatos, CA 95032

All donations are 100% tax deductible and Where: 100% of donation goes to Goals for Girls. Bellomy Field Tax ID EIN#: 37-1491098 500 El Camino Real Santa Clara, CA 95053

Why: Come have fun, learn and be Register Before May 1 inspired by female role models. Extra T-shirt…………………….$10 Clinic + Picture*+ T-shirt…$50 Fundraising will benefit Goals for Girls. Established since 2007, Goals Register After May 1 for Girls has helped disadvantaged Extra T-shirt….…………………$10 girls through its unique international Clinic + Picture*+ T-shirt…$75 platform by providing access to health and life skills education *A picture with Brandi, Leslie, Cindy, Aly and you. Note: All donations are 100% tax deductible and programs that empower young 100% goes to Goals for Girls girls. All taught through the game of More camp info, general camp info and soccer. sponsorships: Contact Laurie Bertani @ [email protected]