Elite Soccer Program
Player Name:___________________________________
Club: ____________________
Parent’s First Name: ___________________
Parent’s Last Name: ___________________
Phone:
__________________________
Cell Phone: __________________________
Email 1:
__________________________
Email 2:
__________________________
***Send to Brett Gregory: Fax 502.899.3566, Email bgregory@mockingbirdsoccer.net OR Mail to MVSC, 3000 Mellwood Avenue, Louisville, KY 40207***
The purpose for the Elite Soccer Program is to provide all KFJ+LSA+OSC+ SIU identified elite boys and girls born in
2002-2005, the opportunity to train together throughout the winter months in an effort to help improve youth soccer
as a whole in our area. Players will be selected from each of the participating Clubs to take part in a bi-weekly
training session, led by a select number of highly experienced coaches from each Club. The players selected may
change from week to week. A highly detailed training plan has been put in place, which will see our top players
challenged even further. The training program will be for U12 and U14 Boys and Girls and will be completely free
for the players invited to participate.
Details:
 Saturday, January 9th
 Saturday, January 23rd
 Saturday, February 6th
 Saturday, February 20th
 Saturday, February 27th
** All sessions will take place at Floyd Central High School Football Field. 6575 Old Vincennes Rd, Floyds Knobs, IN 47119
** Specific times TBD
Parent/Guardian Agreement—Please read carefully and sign below
In consideration of registering my child (or dependent, if Guardian; both hereinafter referred to as “Participant”)
for the Elite Soccer Program, I certify that Participant is of normal health and in proper physical condition to
participate in the Elite Soccer Program and has not been otherwise informed by a physician. On behalf of
Participant, I acknowledge that I am aware of the risks inherent in participating in indoor soccer (both practice and
competition); that indoor soccer is a physical sport which can require considerable running, starting, stopping and
physical exertion; in heat and humidity; and could potentially lead to overheating and dehydration; possible limb
injuries; possible permanent disability and death; and agree to assume all of those risks and to waive any and all
rights to claims for injuries, loss or damages arising out of the Participants participation in the Elite Soccer
Program.
I further certify that the Participant maintains adequate health insurance to cover any injuries occurring as a result
of participation in the Elite Soccer Program.
In the event that I cannot be reached in an emergency, I hereby give permission to the Elite Soccer Program staff to
secure emergency medical services including transportation and physician.
Signature of Parents: ______________________________________________
Date: ___________________