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Youth Soccer Clinic Registration 2011
The South Dakota State University women's soccer team will host a free youth clinic on Sunday, Oct. 16. The clinic will run from 11:30 a.m. to 12:30 p.m. at Fishback Soccer Park in Brookings. Please remember to bring shin guards and a soccer ball to the clinic. To register a child in grades K-8, please fill out all fields completely. One form must be filled out per child. For questions, please contact the Jackrabbit Ticket Office at 1-866-GO JACKS (465-2257).

Required Fields in Bold

First Name of Clinic Participant
Last Name of Clinic Participant
Grade in School
Birthdate (mm/dd/yy)
Name of Parent/Guardian
Street Address
City, State Zip
E-mail Address
Emergency Contact Number (for day of clinic)
Medical Insurance Company
Policy Number
In consideration of the acceptance of this application by clicking the submit button, I, intending to be legally bound hereby for myself, my heirs, executors, administrators, waive and release any and all rights and claims for damages against South Dakota State University, or its representatives and/or assignees for any and all damages which may be sustained and suffered out of my traveling to, participation in and returning from camp. Please note that medical insurance information will be used only in emergency situations and will not be provided to any third party.
I agree to these considerations
I would like to receive information regarding Junior Jacks, tickets, and athletic events at South Dakota State University.