Street Soccer Training Camp
REGISTRATION FORM
Street Soccer Training Camps 2016 “Six weeks training method”
Ages 5-14 boys & girls June 7th – July 14th 2016 Tuesday & Thursday 6:00pm - 7:30pm
Street Soccer Special $195.00
$85.00 per player
□
Street Soccer Training Camp
per player
□
Street Soccer Advanced Training Camp (Qualified players only for Advanced TC)
____________________________________
Birth Date:
______________________
Male
Female
Experience:
Circle appropriate age group: U-6
Parent’s Name: Parent’s Cell:
U-8
U-9
Recreational U-10
U-11
Age:
________
Competitive U-12
U-13
U-14
U-15
□ Youth Small □ Youth Medium □ Youth Large □ Youth X-large □ Adult Small □ Adult Medium □ Adult Large □ Adult X-large
_______________________________________________
_________________________ Home Phone: ________________
Home Address:
_______________________________________________ City
Email:
$125.00
PARTICIPANT
PLEASE PRINT CLEARLY
Circle:
Special $250.00
Puryear Sports Complex 5701 Lee Street NE St. Petersburg, FL 33703
CHOOSE ONE CAMP:
Name:
Street Soccer
State
Zip
_________________________________________________
PLEASE PRINT CLEARLY
WAIVER BY SUBMITTING THIS REGISTRATION, I HEREBY RELEASE ST. PETE RAIDERS/CENTRAL ACADEMY YOUTH SOCCER ASSOCIATION AND ALL ITS MEMBERS FROM ANY AND ALL CLAIMS AND LIABILITY OF ANY KIND OF PERSONAL INJURY OR PROPERTY DAMAGE DUE TO PARTICIPATION IN THIS CAMP. I CERTIFY THAT MY CHILD IS IN GOOD HEALTH AND IS ABLE TO PARTICIPATE IN ALL ACTIVITIES. IF ANY ATTENTION IS REQUIRED FOR ILLNESS OR INJURY, I GIVE MY PERMISSION TO A STAFF MEMBER FOR SUCH CARE. NO REFUND POLICY.
_________________________ Phone: _____________ PARENT SIGNATURE X_______________________________ DATE: _________ Emergency Contact Name:
NOTE: ALL PARTICIPANTS MUST SIGN WAIVER (PARENT/GUARDIAN IF UNDER 18)
Street Soccer _____________ Street Soccer Adv._____________ Socks _____________ Shin guards _______________ CASH Amount $ _____________ CHECK Amount $ _____________ Check # _____________Driver’s License # ______________________________ ***Please make check payable to CAYSA. Returned check is subject to a $40.00 charge) Notes: ___________________________________________________________________________________________________ GRAND TOTAL: ____________________________________
Gerald Morin, Founder of Street Soccer/Street Soccer Advanced TC, [email protected], (727)742-6883 GM 2016
Street Soccer Training Camps 2016 “Six weeks training method”
Ages 5-14 boys & girls June 7th – July 14th 2016 Tuesday & Thursday 6:00pm - 7:30pm
Street Soccer Special $195.00
$85.00 per player
□
Street Soccer Training Camp
per player
□
Street Soccer Advanced Training Camp (Qualified players only for Advanced TC)
____________________________________
Birth Date:
______________________
Male
Female
Experience:
Circle appropriate age group: U-6
Parent’s Name: Parent’s Cell:
U-8
U-9
Recreational U-10
U-11
Age:
________
Competitive U-12
U-13
U-14
U-15
□ Youth Small □ Youth Medium □ Youth Large □ Youth X-large □ Adult Small □ Adult Medium □ Adult Large □ Adult X-large
_______________________________________________
_________________________ Home Phone: ________________
Home Address:
_______________________________________________ City
Email:
$125.00
PARTICIPANT
PLEASE PRINT CLEARLY
Circle:
Special $250.00
Puryear Sports Complex 5701 Lee Street NE St. Petersburg, FL 33703
CHOOSE ONE CAMP:
Name:
Street Soccer
State
Zip
_________________________________________________
PLEASE PRINT CLEARLY
WAIVER BY SUBMITTING THIS REGISTRATION, I HEREBY RELEASE ST. PETE RAIDERS/CENTRAL ACADEMY YOUTH SOCCER ASSOCIATION AND ALL ITS MEMBERS FROM ANY AND ALL CLAIMS AND LIABILITY OF ANY KIND OF PERSONAL INJURY OR PROPERTY DAMAGE DUE TO PARTICIPATION IN THIS CAMP. I CERTIFY THAT MY CHILD IS IN GOOD HEALTH AND IS ABLE TO PARTICIPATE IN ALL ACTIVITIES. IF ANY ATTENTION IS REQUIRED FOR ILLNESS OR INJURY, I GIVE MY PERMISSION TO A STAFF MEMBER FOR SUCH CARE. NO REFUND POLICY.
_________________________ Phone: _____________ PARENT SIGNATURE X_______________________________ DATE: _________ Emergency Contact Name:
NOTE: ALL PARTICIPANTS MUST SIGN WAIVER (PARENT/GUARDIAN IF UNDER 18)
Street Soccer _____________ Street Soccer Adv._____________ Socks _____________ Shin guards _______________ CASH Amount $ _____________ CHECK Amount $ _____________ Check # _____________Driver’s License # ______________________________ ***Please make check payable to CAYSA. Returned check is subject to a $40.00 charge) Notes: ___________________________________________________________________________________________________ GRAND TOTAL: ____________________________________
Gerald Morin, Founder of Street Soccer/Street Soccer Advanced TC, [email protected], (727)742-6883 GM 2016
