Registration - Fall MiniBlaster 2025
Fall MiniBlaster 2025

The MiniBlaster sessions are specifically designed for children ages 4 thru 7 to provide a good introduction to the game of soccer. The program will help children develop motor skills, coordination and an overall love for the game. It is designed to teach basic soccer skills including dribbling, shooting, passing and trapping, in a fun and safe environment.

This is a 7 week session, one hour per week, beginning the week of September 2, 2025.

Where:
Minisink Soccer Fields
River Road
East Stroudsburg, PA

When:
Sign up for the day based on the birth year of your child. The program will begin the week of September 2, 2025.

Cost: $80.00

Name
Address
City, State Zip
Phone
Email
Date of Birth (MM/DD/YYYY)
How did you hear about our program?
T-Shirt Size
Parent/Guardian Contact Information
Parent/Guardian Name
Medical Information
Phone
Allergies
Allergies (if yes, please list)
Other Medical Concerns
Medical Insurance Company
Insurance Company Phone
Policy Holder Name
Policy Number
Group #

Please select the package that corresponds to the day of the week your player will be attending, Monday, Tuesday, Wednesday, or Thursday based on the birth year of your child. Once selected your player will attend sessions on that day of the week for the duration of the program.

2025 Fall MiniBlaster
$80.00
Birth Year 2017
2025 Fall MiniBlaster (Birth Year 2017)
Monday6:45 pm
$80.00
Birth Year 2017
2025 Fall MiniBlaster (Birth Year 2017)
Wednesday6:45 pm
$80.00
Birth Year 2018
2025 Fall MiniBlaster (Birth Year 2018)
Monday6:45 pm
$80.00
Birth Year 2018
2025 Fall MiniBlaster (Birth Year 2018)
Wednesday6:45 pm
$80.00
Birth Year 2019
2025 Fall MiniBlaster (Birth Year 2019)
Tuesday6:45 pm
$80.00
Birth Year 2019
2025 Fall MiniBlaster (Birth Year 2019)
Thursday6:45 pm
$80.00
Birth Year 2020
2025 Fall MiniBlaster (Birth Year 2020)
Monday5:30 pm
$80.00
Birth Year 2020
2025 Fall MiniBlaster (Birth Year 2020)
Wednesday5:30 pm
$80.00
Birth Year 2021
2025 Fall MiniBlaster (Birth Year 2021)
Tuesday5:30 pm
$80.00
Birth Year 2021
2025 Fall MiniBlaster (Birth Year 2021)
Thursday5:30 pm
Players will need to wear shin-guards, soccer socks and soccer cleats. They should bring plenty of drinking water.

Please contact Maria Francis at mfrancis@fcpocono.org or call (570) 213-1023 with any questions.

Medical Release:

Please note that by signing this Medical Release Form you recognize the possibility of physical injury associated with soccer and in consideration for FC Pocono and its affiliates accepting the registrant for its soccer programs and activities ("the Programs"), I hereby release, discharge and/or otherwise indemnify FC Pocono, its affiliated organizations and sponsors, their employees and associated personnel, including the owner of the fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.

My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programs. I hereby give my consent to have an athletic trainer and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the cost of each assistance and/or treatment.


COMMUNICABLE DISEASE
RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT

In consideration of being allowed to participate in any way in any program, event or activity sponsored or sanctioned by the Eastern Pennsylvania Youth Soccer Association, I the undersigned, acknowledge, appreciate, and agree that:
I am aware there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or resulting from an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any mutation or variation thereof.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS FC POCONO, its officers, officials, agents and/or employees (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.


I have read and agree to all terms and conditions aboveParent or Guardian Initials for Consent