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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       


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.