www.FCMirage.com 847-732-1052

2017 WINTER INDOOR SOCCER CLINICS

(BOYS & GIRLS / AGES 6 - 11)

MONDAYS: Ages 6 - 10 Section I: 10 Sessions

THURSDAYS: Ages 11-13 Section II: 10 Sessions

MONDAYS TIMES __ January: 9, 16, 23, 30 6:30 – 7:30pm February: 6, 13, 20, 27 6:30 – 7:30pm March: 6, 13 6:30 – 7:30pm

THURSDAYS TIMES__ January: 12, 19, 26 6:30 – 7:30pm February: 2, 9, 16, 23 6:30 – 7:30pm March: 2, 9, 16 6:30 – 7:30pm

COST: $160 per player for 10 Sessions (NEW players receive an FC Mirage T-Shirt)

Able to attend only select dates? No problem, we will Pro-Rate the cost. DISCOUNTS: Players from the same family? Take 10% off of younger player’s fee

All current FC Mirage players receive 20% off Location & Directions: Indoor Gym at the Glenview New Church

74 Park Drive, Glenview, IL 60025 From 94(41) take Lake Ave. Exit west to Shermer Rd. & turn right on Glenview Rd. Turn right on Park Drive then go left at the “T.” Parking is located on the northwest corner of the church in front of the gym. Clinic Overview: The purpose of these clinics is to help all players who desire to become better soccer players. The overall goal is to provide assistance to players who want to further their progress in soccer by strengthening their basic skills, foot-eye coordination, balance, endurance, decision-making, as well as overall game play. Serving as a low-pressure introduction to travel soccer, new players have integrated into existing teams through attending indoor clinics. Existing players attend clinics as a way to continue growing during the winter season. What to Bring: Indoor soccer shoes, soccer shorts, shin guards, soccer socks and soccer ball. Registration and Payment: Email your player’s Name, D.O.B. and Preferred Session (Mondays OR Thursdays) to info@fcmirage.com; fill out the Registration & Consent Form and bring it to the first clinic you attend along with payment in cash or check (checks payable to FC Mirage).

F.C. MIRAGE SOCCER

2017 Indoor Soccer Clinic Registration and Consent Form

Note: Existing Mirage players do not need to fill out this form

Player’s Name: ________________________________________________ Date of Birth: _____________ Gender: M F Phone: _____________ Address: ______________________________________________________ City: __________________________ State:______ ZIP: _____________ Mother’s Name: _________________ Cell Phone: ____________________ E-mail: ________________________ Work Phone: ___________________ Father’s Name: __________________ Cell Phone: ____________________ E-mail: ________________________ Work Phone: ___________________ Emergency Contact: ___________________ Phone: ___________________ Previous Soccer Experience: Positions Played: ________________ Previous Clubs: _________________ Does the player have any disabilities, handicaps, present injuries, or limitations, allergies, hemophilia, heart condition, history of respiratory illness or any other significant medical illness that might affect his or her participation in the sport of soccer? NO YES (please explain) _____________________________________________ ________________________________________________________________________ ________________________________________________________________________ Participation Agreement and Liability Release Consent and Release: I acknowledge that soccer is a contact sport, which involves the possible risk of injury. I consent to my child’s participation in F.C. Mirage (FCM) soccer program and summer camp. I, individually, and on behalf of my child, do hereby release and forever discharge FCM, its shareholders, officers, members, coaches, directors, agents and representatives from any and all liability of whatever nature relating to or in any matter arising out of my child’s participation in any and all programs offered by the FCM. I agree to hold the FCM harmless and indemnify it for any damages, which may be sustained in connection with our association or with participation in the FCM soccer program. I understand that personal injuries can occur before, during, and after soccer games, practices or camps by reason of field preparation and conditions, equipment conditions, and contact with participants, FCM personnel and spectators. This release shall apply to any personal injury or other loss whether or not reasonably anticipated, expected, or contemplated at this time. This release is indemnification shall be binding upon my personal representatives, heirs and assigns. __________________________________________________________________ Parent or Guardian Signature Date