UK Premier School Fall 2008 Registration Form

(Include Questions in Staff Notes)

Return to Registration Selection Page.. Click Here

BLAST WEB SITE
First Name  
Last Name  
Parents Name    
Address  
City  
State    Zip  
Phone #1  
Phone #2  
E-mail Address  

Age  

 
  Male    Female
Please choose the program you are registering for:
Payment Information
Payment is accepted online.  Acceptance into a BLAST league or event is not guaranteed until payment is received. Submission of this registration form will generate an invoice mailed to the registered address.
  Payment Options    

 

 Bill Me Visa Master Card
 
Cardholders Name
Card Number - - -
Expires
(if different from above) Address on Card
(if different from above) Zip Code
V-Code   (What is a V-code?)
Roster and Waiver

WAIVER/EXCLUSION (Please Read Carefully)  I, the parent or guardian or participant, understand the inherent risks of physical injury involved in sports and do so at my own risk. Participants & parents assume full responsibility for all injuries and damage and forever release, discharge and hold harmless the employees and agents of UK Soccer Camps, Trident Sports, Inc., it's coaches and affiliates from any and all claims, demands, damages & rights of action, present and future resulting from participation in any program or use of facilities.

I Accept the above terms

I Decline the above terms
 
Info to our Staff
Please include any information we need to know below (Scheduling Requests)!

Copyright © 2003 Trident Sports Inc. All rights reserved.
Revised: 09/04/08.