Griffin Soccer Registration Form - Winter Camps
Questions? 408-446-0618 | info@griffinsoccer.com | www.griffinsoccer.com
Email address *
Winter Camps 2017-2018 *
Required
What days of camp will your child attend? *
Required
Player Information
Last Name *
Your answer
First name *
Your answer
Preferred Name
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age as of camp's start date *
Your answer
Gender *
Grade in School *
T-Shirt Size *
Current Level of Play *
If you play for a club or team, what is the name?
Your answer
Parent/Guardian Information
Last name, First Name *
Your answer
Phone Number *
Your answer
Emergency Contact Information
Emergency Contact (Last Name, First Name) *
Your answer
Emergency Contact's Phone Number *
Your answer
Insurance & Medical Information
Insurance Company Name *
Your answer
Policy Number *
Your answer
Allergies
Your answer
Please indicate any other medical conditions, special needs, or behavioral conditions the coaches should be made aware of for camp
Your answer
Other Information
If your player would like to be grouped with a friend or teammate, what is their name?
Your answer
How did you hear about this camp? *
Waiver
I certify that my child is in excellent physical health, and may participate in strenuous and hazardous physical activities, including the soccer and futsal to be played under the direction of Griffin Soccer (GS). I certify that there are no physical limits to my child’s participation. I understand that accidents and injuries can arise from participation; knowing the risks, nevertheless, I hereby agree to assume those risks on behalf of the above named Minor and to release and to hold harmless all of the representatives of the GS. Permission is granted for my child to receive emergency medical treatment if needed. I will be personally responsible for any damages sustained by my child and any invited family participants to any GS equipment and/or any indoor or outdoor facilities rented by GS.In consideration of participation in the program offered above, I, the undersigned, as the parent/guardian of the Minor named above, agree to indemnify and hold GS and its rented facilities harmless and hereby waive, release and discharge any and all claims for damage, for death, personal injury, bodily injury or property damage which I and/or the Minor may have or which hereinafter may accrue to me and/or the Minor against GS and may rise out of negligence or carelessness on the part of GS. For players on soccer teams, my child has his/her coach’s permission to participate in the GS soccer and futsal program. I agree to allow use of photography and videography of my child for publicity. It is understood and agreed that this waiver, release and assumption of risks has been freely entered into and is to be binding on my heirs and assigns. I represent that I am a parent/guardian of the Minor named above and I agree that the grant and release contained therein binds me and the Minor to all its terms. *
Payment Options
Half Day Camp (9 AM to noon) is $225/week or $50/day;
Mini Camp (9 AM to 10:30 AM) is $125/week or $30/day
Check, Credit Card or PayPal? *
Total Due: *
Your answer
A copy of your responses will be emailed to the address you provided.
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