Response

Please fill out the information below to RSVP for Youth Soccer Day on Saturday, July 11.

Prefix

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Phone

First and last name of participant:

What grade is participant entering this fall?

Soccer experience of participant:

Is the participant on a soccer team? If so, name of team:

If the participant has experience playing soccer, please describe it in more detail. For example, does the participant mostly play with family and friends? At school or through a local rec program? With a local club?

Students with all levels of experience are welcome and highly encouraged to attend!

If different than the information above, please provide the name and email of the parent, guardian, or chaperone attending the event with the participant:

Anything else you want us to know?

Permission to attend:

By submitting this form, the parent or legal guardian of the above-named minor participant gives permission to attend this event. They will be accompanied by the adult listed above.

By submitting this form, the parent or legal guardian of the above-named minor participant gives consent to the United States Senate Office of Bernie Sanders to use the participant's image and likeness and/or any interview statements in its publications and other print media, mailings, on television, radio and electronic media, including the Internet, without expectation of compensation or other renumeration, now or in the future. This exclusivity pertains to the United States Senate Office of Bernie Sanders. This consent includes, but is not limited to:

Permission to interview, film, photograph, tape, or otherwise make a video reproduction of the participant and/or record their voice;
Permission to use the participant's name; and
Permission to use quotes from interview(s), film, photograph(s), tape(s), or reproduction(s) of the participant, and/or recording of their voice, in part or in whole.

This consent is given in perpetuity, and does not require prior approval.