UPPER90 FUTSAL WINTER CAMP

UPPER90 FUTSAL ACADEMY

2020-21 WINTER CAMP
UPPER90 Winter Futsal camp will take place on the following dates:

WEEK 1 CAMP : DECEMBER 28-31

START TIME: 5:00 PM

END TIME: 7:00 PM

WEEK 2 CAMP : JANUARY 04-07

START TIME: 5:00 PM

END TIME: 7:00 PM
Athlete Information
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Gender

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Additional Player Information
Name of School
Do you play for a Club?
If Yes, which club?
What position(s) do you play?
Preferred foot?
T-Shirt size (Youth)
Parent/Guardian Information
Name *

First Name Last Name
Home Number

Area Code Phone Number
Cell Number

Area Code Phone Number
E-mail
Address (if different from the player's)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by the UPPER90 FUTSAL WINTER CAMP during the selected camp. In exchange for the acceptance of said child’s candidacy by the UPPER90 FUTSAL WINTER CAMP, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the UPPER90 FUTSAL WINTER CAMP and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against the UPPER90 FUTSAL WINTER CAMP, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer.
*

I Agree
Confirmation

BY AGREEING ABOVE AND SUBMITTING THIS FORM, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT IS EQUIVALENT TO AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Products

WEEK 1 CAMP $ 120.00

WEEK 2 CAMP $ 120.00

BOTH CAMPS 1, 2 $ 220.00

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Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

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UPPER90 FUTSAL ACADEMY

Additional Player Information