APPLICATION
APPLICATION
Please print and fill out the application and send it to our address with check payable to
Four Seasons Soccer, P. O. Box 93, Germantown, MD 20875
__________________________________________________________________
Please choose one option:
summer camp: half day am pm or full day
team training camp
Location:___________________________________________________
Date:______________________________________________________
Child's name:________________________________________________
Address: __________________________________________________
City, State, Zip Code _________________________________________
Age at Camp _____ Date of Birth__/__/__ Female__ Male __
Email address:__________________________________________________
Home Phone Number:________________________________________
Parent's Name: _____________________________________________
Parent's Work Phone: ________________________________________
Emergency contact and phone number: ___________________________
Please indicate any medical or special instructions:__________________
_________________________________________________________
Health and liability information
Name of insurance___________________ Policy#_____________________
I certify that my child is in good physical condition and can participate in Four Seasons Soccer Academy program. In case of medical emergency I give permission to receive emergency medical treatment. I waive and release all staff and officials of the soccer camp from all liability for any injuries and illness incurred while participating in the program.
______________________________ _______
Parent/Guardian Signature Date
Please note, if you need to cancel a week of summer camp you need to do so two weeks prior to the first day of camp and there will be $75 nonrefundable fee.
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