Midwest Soccer Academy, 5247 Fyler, St. Louis, Mo. 63139, 314-781-8493
Party Application
Please call to verify date and time before submitting
Date requested Time
Parent’s Name
Address
Home Phone Cell
Email Address
Number attending Child’s name Age
Select Party Package:
75 minutes in the soccer gym, 45 minutes in the party room, 4 pitchers of soda, decorations & party ware for 25. Cost: $125.00
75 minutes in bb gym, 45 minutes in the party room, 4 pitchers of soda, decorations & party ware for 25. Cost:$125.00
75 minutes in the inflatables, 45 minutes in the party room, 4 pitchers of soda, decorations & tableware for 25. Cost: $225.00
Soda choices:
Ala Carte Items
No outside or beverages are pemitted without approval of Midwest Soccer Academy, with the exception of cake.
Agreement
AS A PARENT/GUARDIAN OR OTHER ADULT HOSTING THIS EVENT, I UNDERSTAND THAT THERE ARE RISKS OF INJURY WHEN 1 PARTICIPATES IN SPORTS AND
OTHER ACTIVITIES AT THIS FACILITY (MIDWEST SOCCER ACADEMY), I ALSO UNDERSTAND THAT MIDWEST SOCCER ACADEMY IS NOT ACCEPTING OR ASSUMING
ANY DUTIES OR RESPONSIBLITIES WITH RESPECT TO MY CHILD’S OR ANY OTHER PARTY GUEST’ SAFETY THEREFORE IN CONSIDERATION OF THE PERMISSION
EXTENDED TO ME ENTER THESE PREMISES, I RELEASE AND FOREVER DISCHARGE MIDWEST SOCCER ACADEMY, FROM ANY CLAIMS THAT I HAVE, OR MIGHT
HAVE IN THE FUTURE HAVE ARISING OUT OF OR CONCERNING MY PRESENCE AT THIS FACILITY OR MY PARTICIPATION IN ANY ACTIVITY AT THIS FACILITY, AND I
PROMISE TO IMDEMNIFY MIDWEST SOCCER ACADEMY AND HOLD IT HARMLESS FROM ANY CLAIMS AND RELATED DEFENSE COSTS, INCLUDING REASONABLE
ATTORNEY FEES, ARISING OUT OF MY PRESENCE OR PARTICIPATION IN ANY ACTIVITIES AT THIS FACILITY. IN ADDITION, I HEREBY AUTHORIZE MIDWEST SOCCER
ACADEMY AND IT’S RESIGNS TO UTILIZE AND ALL PHOTOGRAPHS, PICTURES, OR OTHER LIKENESS OF THE PARTIIPANTS THEY DEEM APPROPRIATE IN IT’S
PROMOTIONAL MATERIALS.
PARENT/GUARDIAN SIGNATURE DATE
PLEASE RETURN THIS WITH A $25.00 DEPOSIT TO RESERVE YOUR PARTY DATE.
Check Number Check Amount
Name on card Card #
Expiration Date Security Code
