Register

To Register:
1. Please read The Parent/Guardian Approval & Medical Release (below)
2. Complete online form
3. Pay appropriate fees

Parent/Guardian’s Approval & Medical Release

Recognizing the possibility of physical injury associated with football and in consideration for the Football IQ Academy and affiliates accepting the registrant for its football  programs and activities ( the “Programmes”), I hereby release, discharge and/or otherwise indemnify the Football IQ Academy, its affiliated organizations and sponsors, their employees and  associated personnel, including the owners of the fields and facilities utilized for the Programmes against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programmes and/or being transported to or from the same, which transportation I hereby authorize.

My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programmes. I hereby give my consent to have an athletic trainer and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of such assistance and/or treatment.

Registration Form

First Name*

Surname*

Date of Birth*

12345678910111213141516171819202122232425262728293031  Day  JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember  Month  20042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032  Year

Gender*

Select OneMaleFemale

Level Played*

Select OneBeginnerRecreationalSchool TeamClub/Academy Team

Session Registering for: Saturdays

Parent/Guardian Name*

Parent/Guardian Email*

Parent/Guardian Contact #*

For the Alternative Contact Name and Alternative Contact #, please provide the name and phone number of a person other than the Parent/Guardian and Contact # in the event that we are unable to contact the Parent/Guardian.

Alternative Contact Name*

Alternative Contact Phone #*

Any Medical Conditions

I have read and accepted the Approval & Medical Release*

How did you hear about Football IQ Academy?*

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