Walking Registration | Soccer Alliance Miss

SAM Walking Soccer Registration & Waiver

First name

Last name

Date of Birth

Address

Do you have any physical limitations that may restrict movement & rigorous activities?

Yes

If yes, please specify condition that may limit movement & activities

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Sign

SAM requests a $35 donation to participate in Walking Soccer Club games to cover insurance and field rentals. All extra proceeds will go to Missoula Adaptive Recreation & Sports

Thanks for submitting!