BSTC SOCCER SUMMER CAMPS 2013 REGISTRATION FORM
BSTC SOCCER SUMMER CAMPS 2013 REGISTRATION FORM You are invited to come learn skills, techniques and have a lot of fun in our Summer Soccer Pograms. Our summer camps help new players and advanced players prepare for next season tryouts and school teams.
Child Name D.O.B.
Age
Parent email address Parent Name: Home Phone#
Cell Phone #
Parental Release:
My son/daughter is in good health and has my full permission to participate in the BSTC summer soccer program. He/she has had no previous sickness, illness, disease or body injury that is contradictory to participation. I fully understand that soccer is a contact sport and that physical injury may occur during the course of practice and games. As well I give permission to take and use photographs of the child in the BSTC summer soccer program to be used for publicity about the program as deemed appropriate by BSTC Management. In the event that I cannot be reached I give my full permission for medical attention to be provided. I agree to be responsible for such charges as apply to that care.
Signed:
Print Name:
Date: Check the week(s) you are interested in participating:
Week 1 June 10 - June 14 ( )
Week 2 June 17 - June 21 (
)
Week 5 July 8 - July 13 ( )
Week 6 July 15 - July 19 ( )
Week 8 July 29 - August 2 ( ) Week 9 August 5 - August 9 ( )
Week 3 June 24 - June 28 (
) Week 4 July 1 - July 5 ( )
Week 7 July 22 - July 26 ( ) Week 10 August 12 - August 16 ( )
Times and Prices (Register before May 31 for 10% Discount) PEEWEE CAMP Ages 3 - 4 = $100 per week From 4 pm - 5 pm JUNIOR CAMP Ages 5 - 12 = $150 per week From 5 pm - 6:30 pm ELITE CAMP Ages 13 - 15 = $150 per week From 6:30 pm -8 pm Payment Information Payment can be made by Visa or Master Card or American Express or by Check to Brazilian Soccer Training Center. Check # _________________ Credit Card Type: Master Card( ) Visa( ) American Express ( ) I authorize Brazilian Soccer Training Center to charge on my credit card the amount of $ ______________________ Credit Card # Expiration Date:
CVV Code:
Signature:
Date:
Card Holder's Name: Card Holder's Address: City: Phone:
State:
Zip Code:
Country:
Email:
PLEASE RETURN THE COMPLETED FORM TO COACH JOAO OR COACH GOZ You may also scan and send the form by email or register online at the website. Brazilian Soccer Training Center EMAIL:
[email protected]
Phone 305-865-8020 Mobile 786-337-3208 WEBSITE: www.bstcsoccer.com
Child Name D.O.B.
Age
Parent email address Parent Name: Home Phone#
Cell Phone #
Parental Release:
My son/daughter is in good health and has my full permission to participate in the BSTC summer soccer program. He/she has had no previous sickness, illness, disease or body injury that is contradictory to participation. I fully understand that soccer is a contact sport and that physical injury may occur during the course of practice and games. As well I give permission to take and use photographs of the child in the BSTC summer soccer program to be used for publicity about the program as deemed appropriate by BSTC Management. In the event that I cannot be reached I give my full permission for medical attention to be provided. I agree to be responsible for such charges as apply to that care.
Signed:
Print Name:
Date: Check the week(s) you are interested in participating:
Week 1 June 10 - June 14 ( )
Week 2 June 17 - June 21 (
)
Week 5 July 8 - July 13 ( )
Week 6 July 15 - July 19 ( )
Week 8 July 29 - August 2 ( ) Week 9 August 5 - August 9 ( )
Week 3 June 24 - June 28 (
) Week 4 July 1 - July 5 ( )
Week 7 July 22 - July 26 ( ) Week 10 August 12 - August 16 ( )
Times and Prices (Register before May 31 for 10% Discount) PEEWEE CAMP Ages 3 - 4 = $100 per week From 4 pm - 5 pm JUNIOR CAMP Ages 5 - 12 = $150 per week From 5 pm - 6:30 pm ELITE CAMP Ages 13 - 15 = $150 per week From 6:30 pm -8 pm Payment Information Payment can be made by Visa or Master Card or American Express or by Check to Brazilian Soccer Training Center. Check # _________________ Credit Card Type: Master Card( ) Visa( ) American Express ( ) I authorize Brazilian Soccer Training Center to charge on my credit card the amount of $ ______________________ Credit Card # Expiration Date:
CVV Code:
Signature:
Date:
Card Holder's Name: Card Holder's Address: City: Phone:
State:
Zip Code:
Country:
Email:
PLEASE RETURN THE COMPLETED FORM TO COACH JOAO OR COACH GOZ You may also scan and send the form by email or register online at the website. Brazilian Soccer Training Center EMAIL:
[email protected]
Phone 305-865-8020 Mobile 786-337-3208 WEBSITE: www.bstcsoccer.com
