Golden Goal Soccer Academy 2010 Registration Form

Golden Goal Soccer Academy Registration Form

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* Indicates required field

Parent Information

Name*

Address*

City*

State*

Zip Code*

E-Mail Address*

Camper Information

Name*

Age*

Ball Size*

Shirt Size*

Medical Conditions (If any)

Camp Week*

June 28 - July 2
July 12 - 16 (Whitman HS)
August 2 - 6
August 9 - 13 (HS Prep)

Full/Half Day*

Emergency Contacts*

Team/Group Discount (Separate names by comma, label siblings with (Brother/Sister) by their name)

How did you find us?

Release

SOCCER IS A PHYSICAL SPORT. I hereby give permission and approval for my child, or legal ward, to participate in Kert Mease’s Golden Goal Soccer Academy (the Academy). I assume all risks and hazards incidental to such participation, and hereby release the Academy and it employees and agents from any and all liability arising from injury or injuries sustained by my child, or legal ward, while participating in the camp and related activities. The Academy assumes no responsibility for damage to or loss of property.I also authorize the Academy to make decisions regarding and/or obtaining medical care for injuries and illness that affect my child, or legal ward, or which might occur during the camp. I further direct all medical or hospital facilities to accept this document as authorization to render emergency care to my child, or legal ward, should it be deemed medically necessary.

Photo Release

By checking this box, you DO NOT give the Golden Goal Soccer Academy permission to use a photo of your child, or legal ward, taken during camp in future brochures or on our website Golden Goal Soccer Academy permission to use a photo of your child, or leg

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