Youth Soccer Camp Registration Form

Age Groups:

Ages 5-6

Ages 7-8

Ages 9-11

*age groups vary on attendance

$25 per registration

*Only one registration per child is needed to attend both camp dates.

*Group Rates : Please email us if you have 4 or more campers to receive a group discounted rate.

*Each camper will have to have a registration form completed.

email: eric.nebula@icloud.com

Camper's Personal Information

Camper's Full Name*

First NameLast Name

Camper's Birth Date*

MonthDayYear

Gender

MaleFemale

Camper's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name of School

Do you currently play for a Club?*

If Yes, which club and what position(s) does camper play?

What is the camper excited to learn about at camp?

List three or more of the camper’s interests related to soccer.

Positions, teams, players, etc...

T-Shirt Size (Youth)*

Camper's Health Information

Do you have any allergies?*

Foods, Medicines, Plants, Etc...

Any allergies?

Foods, Medicines,Plants, etc.

Any relevant medical conditions that could interfere with camp activities?*

Any special accomodations required?

Parent/Guardian Contact Information

Primary Contact Full Name*

First NameLast Name

Mobile Number*

Area CodePhone Number

E-mail*

Address (if different from the camper's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by FC Guardians Soccer Academy during the selected camp. In exchange for the acceptance of said child’s candidacy by the FC Guardians Soccer Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the FC Guardians Soccer Academy and all its respective coaches, trainers, managers and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against the FC Guardians Soccer Academy, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I give permission for camp trainers and coaches or contracted health care to start
preliminary treatment and arrange transportation for me or my child to a local Emergency Room in the event that I or my child become(s) ill or injured.

By checking, "I AGREE" on this Informed Consent and Acknowledgement, I acknowledge that I HAVE READ AND FULLY UNDERSTAND AND AGREE TO ALL OF ITS TERMS AND CONDITIONS INCLUDING PERMISSION TO TREAT AGREEMENT. I further state that I have executed this waiver and liability voluntarily and with full knowledge of its significance to be binding on my, my heirs, executors, administrators and assigns.

I AGREEI DO NOT AGREE

Confirmation

BY AGREEING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Select an option:*

Individual Camp Registration$25

Child Registration

Enter coupon

Total $0.00

Camper's Knowledge and Interests