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Thank you for filling out the form below.
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The field marked with (*) are required fields.
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By checking here I understand that I must be a Mt. Laurel club member to receive the rate of $175. for the Series.
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Yes
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Athletes First name
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Athletes Last Name
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Street Address
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City
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State
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Zip code
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Gender
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Month/Day/Year mm/dd/yyyy
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Position typically played
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I myself, my spouse, my child, and on behalf of my/ our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, Net Edge Training,Far Post Soccer, coaches, owners and instructors , other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the training (" Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I understand and accept that pictures/ videos taken at clinics, training and camps may be used for promotional purposes. I grant permission for my child to receive emergency medical treatment. I also assume full financial responsibility for any medical treatment for my child. BY CHECKING THE BOX BELOW I ACKNOWLEDGE THAT I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, THAT I FULLY UNDERSTAND AND AGREE TO ITS TERMS.
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Yes
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Name of Parent or Guardian
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Home Phone
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Cell Phone
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E-mail
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Program Selection
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Thank you. Click SUBMIT to go to the payment page. on the next window click the payment Icon to go to a secure payment page.
Thank you!
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