Complete and print off this form for EACH registering player. 

Return forms & checks (made to "Elite Coaching") to:
Elite Coaching
19310 E. 50th Terrace
Independence, MO 64055

Player Name:

Date of Birth:                                          Current Age:

Street Address:

City:                                                            Zip:

Name(s) of Parents:

Parent Home Phone:                                   Work/Cell Phone:

Parent E-mail:

I would like my child to be considered for the advanced group (all groups receive advanced training).  yes or no

The advanced group will be limited to players that play at a premier level.  Placing a participant in this group that is not ready may result in loss of individual confidence, impedence of entire group's ability to perform drills.  Elite Coaching staff have the final say in placement and may remove a player or add a player at their discretion. 

Team _____________    Coach  _________________  League  ___________________  Division  ___________________

How or who did you hear about us?

I am enrolling for:   
Little Strikers u5 and u6 players  - $60/month
Junior Strikers u7 to u9 players - $60/month
Strikers u10 to u12 players - $60/month
Senior Strikers u13 to HS - $60/month
Junior GK Academy u9 to u11 -$75/month
Senior GK Academy u12 to HS - $75/month

Accepted methods of payment - cash, check or charge.  Make checks to Elite Coaching.

                                                                                                                                                                          ____________
                                                                                                                                                Total Enclosed:

or Pay by Credit Card: 
Please run my credit card upon receipt of this registration form.  My signature indicates my approval of this transaction.

Signature:  _____________________     Date:  ___________

Credit Card Type:

Credit Card Number:

Credit Card Expiration Date:

 I, ____________________________________, (parent or legal guardian) hereby release Elite Coaching, LLC,  and all associates, employees, volunteers, officials and agents associated with this program and KC Sports Lodge, LLC and facilities from any claims, liabilities, loss of services, and cause of action of any kind for personal injury including death and propery damage arising in any way out of participation.  I hereby authorize the supervisors of Elite Coaching, LLC to act for me according to their best judgement in an emergency requiring medical attention.  My son/daughter is fully covered by our personal family health plan in the event of sickness or injury.  Parents and guardians must inform Elite Coaching, LLC of any and all special health needs.  Elite Coaching, LLC reserves the right to utilize images and/or pictures of all program participants for future Elite Coaching, LLC and KC Sports Lodge publications and promotions.

Signature of Parent or Legal Guardian:  __________________________

                                                              Date:  _________________

Questions concerning registration should be directed to:

816-853-1313 or mike@kcsportslodge.com