Iowa City Alliance

Alliance Kixx Program Registration Form

Program information

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The spring 2008 Kixx Program is scheduled to begin on Wednesday, April 23rd, and will run every Wednesday and Friday up to and including Friday, May 23^rd.  The program will run from 5:30pm - 6:30pm at the U of I Soccer Complex Field number TBD.

Player First Name
Player Last Name
Date of Birth
Sex	Male Female
Grade	Choose Grade Kindergarten First Second Third Fourth Fifth Sixth Seventh
Name of School
Program (Day)	Chose Program (Day) KDP (Wednesday) League (Friday) Both (KDPl and League)

Parent Name
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
E-mail

How did you find out about the Kixx Program?

Comments:

In consideration of participation in the 2008 Iowa City Alliance Kixx Program, I
Parent or Legal Guardian Name  
do hereby release the Iowa City Alliance Soccer Club, the University of Iowa, all associates, employees, volunteers, officials and agents from any and all claims, liabilities, loss of service and cause of action of any kind for personal injury and property damage arising in any way out of participation. Further, I agree to abide by all rules and regulation. By agreeing below, I hereby acknowledge that I have read the above, I understand it and agree to all the terms.

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