Crew Soccer Workshops presented by Molina Healthcare

Workshop #1 in Dayton
Where: Kiser Elementary
            1401 Leo Street
            Dayton, OH 45404
When: Tuesday, April 30th @ 5-6:30pm

Workshop #2 in Columbus
Where: Feddersen Park
             3911 Dresden St.
             Columbus, OH 43224
When: Friday, May 3rd @ 5:30-7pm

Workshop #3 in Cincinnati
Where: Walnut Hills High School
             3300 Sulsar St.
             Cincinnati, OH 45207
When: Monday, May 6th @ 5:30-7pm
REGISTRATION IS FULL FOR MAY 6

Workshop #4 in Cleveland
Where: Michael J Zone Recreation Center
            6301 Lorain Ave.
            Cleveland, OH 44102
When: Friday, June 21th @ 5:30-7pm

Workshop #5 in Columbus
Where: McCoy Park
             600 Stimmel Rd.
             Columbus, OH 43223
When: Friday, July 26th, 2013
 

About Molina Healthcare

Molina Healthcare’s mission is to provide quality health services to families and individuals who qualify for government programs. The company was started by an emergency room physician, Dr. C. David Molina, over 30 years ago to provide care to the people who needed it most. In Ohio, Molina has been serving the community since 2005 and currently provides care to approximately 244,000 members.

For more information about Molina Healthcare, visit www.MolinaHealthcare.com

Information
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I allow my child to participate in the Columbus Crew Soccer Workshop. I recognize that my signature on this release is a condition of your permitting my child to participate. I agree that you may photograph and/or videotape my child during the clinic and that you retain the rights to use these visual images in any manner you wish without compensation to my child. I further agree that you may use and license others to use my child’s name, voice, likeness, and any biographical facts which may have been provided to you, including advertising and promoting the clinic. I certify that my child is in excellent physical health, and may participate in strenuous and hazardous physical activities, including the soccer to be played at the workshop. I certify that there are no physical limits to my child’s participation in the workshop. Permission is granted for my child to receive emergency medical treatment if needed. I hereby release and discharge Team Columbus LLC and all affiliated entities from any and all liability, claims demands, and causes of action for personal injury, property damage, and/or other loss suffered by my child in connection with his/her participation in the clinic. I represent that I am a parent/guardian of the minor named above and I agree that the grant and release contained therein binds the minor and me to all its terms.