Winter 2018-2019 Clinics Registration | Transylvania Gym & Soccer

Registration Fee: $275 per each participant at each session

To enroll, a Parent/Guardian must complete this Registration Form and submit it online (by clicking "I AGREE"). A check for $275, payable to: Transylvania Gym & Soccer, must be mailed to the following address: Transylvania Gym & Soccer LLC, 11 Grace Court, Bethel, CT 06801

I am registering my child for the following program:

Wednesdays at Bedford Campus, 5:45pm - 6:45pm, Boys & Girls born in 2011 & 2012

Fridays at Bedford Campus: 4:15 - 5:15, Girls born in 2010, 2011, 2012

Fridays at Bedford Campus: 5:15 - 6:15, Boys born in 2010, 2011, 2012

Fridays at Bedford Campus: 6:15 - 7:15, Boys & Girls born in 2008, 2009 & 2010

Saturdays in Katonah, Harvey School, 9:00am -10:00am, Boys & Girls born in 2011 & 2012

Saturdays in Katonah, Harvey School, 10:00 am -11:00 am, Boys & Girls born 2008, 2009 & 2010

Saturdays in Katonah, Harvey School, 10:00 am -11:00 am, Boys & Girls born 2013 & 2014

Child's Date of Birth

Emergency Phone Number

Parent/Guardian Signature

By typing your name above as the parent/guardian, you agree with the terms outlined below. To enable the Town of Mt Kisco, Rippowam Cisqua School and Transylvania Gym & Soccer LLC to accept registration and permit participation in the Town of Mt Kisco, Rippowam Cisqua School and Transylvania Gym & Soccer LLC’ s activities by the above named player. I player’s parent / guardian, hereby give my consent to his /her participation and agree to release, indemnify, and hold harmless, the Town of Mt Kisco, Rippowam Cisqua School and Transylvania Gym & Soccer LLC, their officers, directors instructors/coaches, and representatives from any claim out for injury arising out of the Town of Mt Kisco, Rippowam Cisqua School and Transylvania Gym & Soccer LLC’ s activities. In case of emergency I hereby authorize treatment and care of player by any hospital, doctor, or emergency or ambulance association.