Summer Soccer Camp Registration Form

In order to submit this registration form, cut and paste it onto a blank document. You can either email it or print it out and send it to the P.O. Box that I have provided you on the bottom of the form....

Clubfoot Soccer Clinics
Summer Soccer Program 2009
August 10th-14th
3-4 year olds 8:00-9:00
5-12 year olds 9:00-12:00
Gage Field Lowell, Ma
Fee: $100

Child’s Name:

____________________________________________________________

Parent’s Name:

___________________________________________________________

Home Address:

___________________________________________________________

Emergency Contact # :

_____________________________________________________

Email:

__________________________________________________________________

Any Food Allergies:

_______________________________________________________

I certify that child(ren) is/are in excellent health and is/are able to participate in physical activity including all sports. I agree to hold CSC and all of their instructors harmless from any and all clairms for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Note: Please include relevant medical information in writing with this application.
I have read and understand CSC’s Waiver Policy.

Guardian’s Signature: __________________________________
Date: _______________

Hayden Barbosa
P.O. Box 8884
Lowell, Ma 01853
978-833-2887
HaydenBarbosa@yahoo.com