Independent Health Foundation's Soccer for Success
Saturday Skills & Open Play Waiver

To participate in the Independent Health Foundation's Soccer for Success Saturday Skill and Open Play days a guardian must complete a waiver.

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* 1. Player First Name

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* 2. Player Last Name

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* 3. Player Date of Birth

Date of Birth

Date

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* 4. Guardian First Name

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* 5. Guardian Last Name

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* 6. Guardian Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

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* 7. Guardian Contact Information

Email Address

Phone Number