2010 KC PACE FASTFORWARD PROGRAM

KC Pace FastForward Program kicks off on March 10th!

The KC Pace FastForward Program is an exciting and elite soccer experience designed to accelerate the youth soccer player’s (boys and girls ages 10-18) development. Directed by the Jefferson Roblee, Lincoln Roblee and Burke Slusher: coaches of the 2005&2006 Missouri state champion KC Pace and the Kansas City Brass (PDL). The FastForward Program will give field players and goalkeepers a fun, progressive environment loaded with proven advanced training techniques of soccer champions.

Wednesday Nights at William Jewell College: March 10-April 28
5:30pm-7:00pm: 3rd-12th grade boys & girls
8 Training Sessions and adidas training jersey
Cost: $150/player (ENROLLMENT LIMITED TO FIRST 20 PLAYERS)

***KC Pace FastForward Program staff have coached more than 70 players who have gone on to achieve All America honors or sign professional contracts.**

PLAYER REGISTRATION & MEDICAL RELEASE
(Registration deadline: March 3, 2010)

Player name____________________________Position_________

Boy______Girl_____
Player birthdate____________________ Current Age____________
Address__________________City______________State_____ZIP_________
Player T-Shirt Size (Circle one): Youth-L Adult-M Adult-L
Parents Names__________________________________________
Home Phone Number___________________________

Parent cell phone #___________________ Accept text messages?_____
Best e-mail address________________________________________
School____________________________________

Club Team________________________________
Club Team Coach___________________________

Club Team Coach Phone #__________________________________
Club Team Coach e-mail____________________________________

I do hereby grant the permission to the KC Pace FastForward Program staff and their respective agents to secure such medical aid and hospital services as they deem necessary for the child noted on this form in the event he/she should sustain and injury or illness while attending the KC Pace FastForward Program. I agree to assume the cost of transportation and medical treatment in such an emergency situation. I have also indicated below any medical information of which the camp should be aware in consideration of the child’s physical and mental well being.
Player Name__________________________________________
Parent Signature_______________________ Date_____________
Family Doctor__________________________________________

Doctor Telephone________________________________________
Special Notes (Allergies)___________________________________
Family Health Care Carrier_________________________________
Health Care GroupName___________________________________
Health Care Policy # ______________________________________

Preferred Hospital________________________________________

I agree that the KC Pace FastForward Program staff and coaches shall not be liable for any injury or loss which my children may sustain while participating in the KC Pace FastForward Program, and I agree to indemnify and to hold harmless the KC Pace FastForward Program from any claim whatsoever. The above applicant is in good health and has my permission to participate in this program. In case of emergency, I grant permission for my son/daughter to be given emergency treatment at a local hospital.
Parent Signature______________________________ Date________________

Please make check ($150) payable to KC Pace FastForward and mail to:
KC Pace FastForward
Attn: Jefferson Roblee
8614 N. Cleveland Lane
Kansas City, MO 64156

Contact Jefferson at FastForward@kcpace.com or (816) 213-1876 for more info.