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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.