REVOLUTON ACADEMY
REGISTRATION

Childs Name*
Childs Birthdate*
Shirt Size*	YS YM YL YXL AS AM AL AXL
Parents First Name*
Parents Last Name*
Address 1*
Address 2
City*
State*
Zip Code*
Email (Primary)*
Email (Secondary)
Phone (Primary)*
Phone (Secondary)
Registration:	Two Session Trial ($20) Five Session Punch ($60)
How did you hear about us?	Friend Poster Website Facebook Other
If by friend please let us know who to Thank!
SOCCER WAIVER AND RELEASE	I understand that my participation in soccer activities is voluntary and that I must be willing and able to demonstrate and physically participate in the soccer activities organized by the Michigan Revolution.To the best of my knowledge I am physically capable of participating in the sport of soccer. I hereby release and indemnify any member of Michigan Revolution staff, the Board of Directors of Michigan Revolution, Coaches, Trainers, Employees, Volunteers or Agents of Michigan Revolution, and / or any organization assisting in soccer activities and / or the owner(s) and/or operator(s) of the facilities where those activities take place, from any liability due to my participation in soccer activities including games, practices, try-outs and any other event organized by the Michigan Revolution.