Top Flight Soccer Camp
2014 TOP FLIGHT SOCCER CAMP Mail-in Registration 1. Check the appropriate Camp Session (√) you are attending: ___ College Prep, Boys 15-18, June 24-27 ___ College Prep, Girls 14-18, July 20-24
___ Future Stars, Boys 10-14, June 25-29 ___ Future Stars, Girls 10-13, July 13-17
TOP FLIGHT SOCCER P.O. Box 244, Fairfax, Va. 22038 571-499-1449,[email protected] www.topflightsoccer.com
Today’s Date: ________ 2. Participant Information
Medical Information:
First & Last Name:
Name of Insurance Co.
Date of Birth: Gender:
Policy Holder's Name
Male
Female Name of Insurance Co.
Home Phone: Policy Number
Address: City & State:
Group Number
ZIP Code:
Date of last tetanus shot
Parent / Guardian Information
List any medical conditions: (allergies, diabetes, injuries...)
First & Last Name: Cell Number: List any medication participant will bring to camp:
Email:
Emergency Contact: Name(s):___________________________________ Cell#(s):____________________________________ Additional CAMP INFORMATION: Playing Position: ___ Field Player ___ Goalkeeper ___ Both
Roommate Request: ____________________________ Teammate request(s): ____________________________ ____________________________ ____________________________ ____________________________
T-Shirt Size: ___ YM ___ YL ___ AS ___ AM Would you like to order ___ AL a camp ball? (add $20 to total) ___ AXL ___ Yes ___No Team Question: Are you coming to camp w/ a team of 12 or more? Y or N
CAMP TUITION RATES: See if EARLY BIRD discount applies: This form must be postmarked prior to May 1. LATE: After May 1
College Prep, Boys (4 days) College Prep, Girls (5 days) Future Stars, (5 days)
$485 $585 $585
EARLY: Prior May 1
$440 $540 $540
Tuition includes: Room, Board (3 meals/day), instruction, Camp T-shirt, 24/7 supervision, recreation and swimming pool usage.
PAYMENT PROCEDURE: Payment options: Personal check or Money Order Pay schedule: You may send a min. deposit of $250 before June 1. All balances are due 2 weeks prior to start of camp. Checks payable to: Top Flight Soccer Mail forms & check to:
Questions:
Top Flight Soccer, P.O. Box 244, Fairfax, VA 22038
[email protected], 571-499-1449
Top Flight Soccer Camp Consent Form, Waiver & Rules Agreement
Camper's Last Name: Date of Birth:
/
/
1. STATEMENT OF CONSENT: I/We, the undersigned, hereby certify that I/We, am/are the parents or legal guardians of the participant on this form. I/We hereby give permission for the camp staff to seek, during the period of camp, appropriate medical attention for the participant, for the attention to be given to the participant, and for the participant to receive the medical attention and treatment including that which is not covered by the Cam p’s excess medical coverage policy and including the Camp's policies deductible. I/We, the undersigned, understand that soccer is an active, physical sport and that injuries can occur. I/We assume all known and unknown risk of injury to my/our child. I/We also understand that there will be more participants than Camp staff at the Camp. I/We hereby acknowledge that my/our child is physically fit and mentally capable of participating in soccer and all Camp activities. I/We, the undersigned, hereby acknowledge and understand the Top Flight Soccer is a privately run sports camp and is not operated by or through Sweetbriar College. The camp is neither sponsored, controlled, nor supervised by Sweet Briar College, but rather is under the sole sponsorship, control, and supervision of the Hasenpfeffer, Inc., t/a Top Flight Soccer. I/We hereby also give permission to Top Flight Soccer and its directors to use any photographs taken of my child during soccer related camp activities as they see fit. This includes promotional items such as camp brochures, camp website, etc. I/We waive, release, and discharge the Top Flight Soccer Camp, Oliver Weiss, Sweet Briar College, and the aforementioned staffs, officers, agents, employees, representatives, successors, and assigns for any and all liability claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, personal injury or property damage that may be sustained or occur during the participation and Camp activities or while at the Camp. 2. RULES AGREEMENT: By signing below you and your son acknowledge, understand, and agree to abide by the rules of the Camp. Violating these rules may result in immediate dismissal from the Camp without a refund. 1. Dangerous objects, weapons, drugs, or alcohol are not permitted. 2. Camp participants shall only be present in locations designated as Camp’s grounds such as designated soccer fields, dormitories, and on campus dining facilities. 3. Bullying, intimidation, or abusive behavior toward any person(s) is not permitted. 4. Visitors or friends of Camp participants are not permitted in the dormitories except with special permission from the Camp’s Directors 5. No participants shall destroy property or engage in reckless behavior. 6. Camp participants shall follow the directions of Top Flight Soccer coaches and staff at all times.
My/our signature(s) indicate(s) that I/We have provided true information on the registration form, medical information, and have read and understand all waivers and consent forms as well as statements on this form.
Signature(s) of Parent(s) or Legal Guardian(s)
Date
Signature(s) of Parent(s) or Legal Guardian(s)
Date
___ Future Stars, Boys 10-14, June 25-29 ___ Future Stars, Girls 10-13, July 13-17
TOP FLIGHT SOCCER P.O. Box 244, Fairfax, Va. 22038 571-499-1449,[email protected] www.topflightsoccer.com
Today’s Date: ________ 2. Participant Information
Medical Information:
First & Last Name:
Name of Insurance Co.
Date of Birth: Gender:
Policy Holder's Name
Male
Female Name of Insurance Co.
Home Phone: Policy Number
Address: City & State:
Group Number
ZIP Code:
Date of last tetanus shot
Parent / Guardian Information
List any medical conditions: (allergies, diabetes, injuries...)
First & Last Name: Cell Number: List any medication participant will bring to camp:
Email:
Emergency Contact: Name(s):___________________________________ Cell#(s):____________________________________ Additional CAMP INFORMATION: Playing Position: ___ Field Player ___ Goalkeeper ___ Both
Roommate Request: ____________________________ Teammate request(s): ____________________________ ____________________________ ____________________________ ____________________________
T-Shirt Size: ___ YM ___ YL ___ AS ___ AM Would you like to order ___ AL a camp ball? (add $20 to total) ___ AXL ___ Yes ___No Team Question: Are you coming to camp w/ a team of 12 or more? Y or N
CAMP TUITION RATES: See if EARLY BIRD discount applies: This form must be postmarked prior to May 1. LATE: After May 1
College Prep, Boys (4 days) College Prep, Girls (5 days) Future Stars, (5 days)
$485 $585 $585
EARLY: Prior May 1
$440 $540 $540
Tuition includes: Room, Board (3 meals/day), instruction, Camp T-shirt, 24/7 supervision, recreation and swimming pool usage.
PAYMENT PROCEDURE: Payment options: Personal check or Money Order Pay schedule: You may send a min. deposit of $250 before June 1. All balances are due 2 weeks prior to start of camp. Checks payable to: Top Flight Soccer Mail forms & check to:
Questions:
Top Flight Soccer, P.O. Box 244, Fairfax, VA 22038
[email protected], 571-499-1449
Top Flight Soccer Camp Consent Form, Waiver & Rules Agreement
Camper's Last Name: Date of Birth:
/
/
1. STATEMENT OF CONSENT: I/We, the undersigned, hereby certify that I/We, am/are the parents or legal guardians of the participant on this form. I/We hereby give permission for the camp staff to seek, during the period of camp, appropriate medical attention for the participant, for the attention to be given to the participant, and for the participant to receive the medical attention and treatment including that which is not covered by the Cam p’s excess medical coverage policy and including the Camp's policies deductible. I/We, the undersigned, understand that soccer is an active, physical sport and that injuries can occur. I/We assume all known and unknown risk of injury to my/our child. I/We also understand that there will be more participants than Camp staff at the Camp. I/We hereby acknowledge that my/our child is physically fit and mentally capable of participating in soccer and all Camp activities. I/We, the undersigned, hereby acknowledge and understand the Top Flight Soccer is a privately run sports camp and is not operated by or through Sweetbriar College. The camp is neither sponsored, controlled, nor supervised by Sweet Briar College, but rather is under the sole sponsorship, control, and supervision of the Hasenpfeffer, Inc., t/a Top Flight Soccer. I/We hereby also give permission to Top Flight Soccer and its directors to use any photographs taken of my child during soccer related camp activities as they see fit. This includes promotional items such as camp brochures, camp website, etc. I/We waive, release, and discharge the Top Flight Soccer Camp, Oliver Weiss, Sweet Briar College, and the aforementioned staffs, officers, agents, employees, representatives, successors, and assigns for any and all liability claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, personal injury or property damage that may be sustained or occur during the participation and Camp activities or while at the Camp. 2. RULES AGREEMENT: By signing below you and your son acknowledge, understand, and agree to abide by the rules of the Camp. Violating these rules may result in immediate dismissal from the Camp without a refund. 1. Dangerous objects, weapons, drugs, or alcohol are not permitted. 2. Camp participants shall only be present in locations designated as Camp’s grounds such as designated soccer fields, dormitories, and on campus dining facilities. 3. Bullying, intimidation, or abusive behavior toward any person(s) is not permitted. 4. Visitors or friends of Camp participants are not permitted in the dormitories except with special permission from the Camp’s Directors 5. No participants shall destroy property or engage in reckless behavior. 6. Camp participants shall follow the directions of Top Flight Soccer coaches and staff at all times.
My/our signature(s) indicate(s) that I/We have provided true information on the registration form, medical information, and have read and understand all waivers and consent forms as well as statements on this form.
Signature(s) of Parent(s) or Legal Guardian(s)
Date
Signature(s) of Parent(s) or Legal Guardian(s)
Date
