UPPER90 FUTSAL SUMMER CAMP

UPPER90 FUTSAL ACADEMY

2021 Summer Camp
UPPER90 FUTSAL ACADEMY SUMMER CAMP 2021

WEEK 1 : JUNE 7, 8, 9 and 10

START TIME: 9:00 AM

END TIME: 12:00 PM

WEEK 2 : JUNE 21, 22, 23 and 24

START TIME: 9:00 AM

END TIME: 12:00 PM

WEEK 3 : JULY 5, 6, 7 and 8

START TIME: 9:00 AM

END TIME: 12:00 PM

WEEK 4 : JULY 19, 20, 21 and 22

START TIME: 9:00 AM

END TIME: 12:00 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
Have you ever played futsal? *
If Yes, with who?
Do you play soccer? *
If Yes, with who?
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 ACADEMY SUMMER CAMP 2021 during the selected camp. In exchange for the acceptance of said child’s candidacy by the UPPER90 FUTSAL ACADEMY SUMMER CAMP 2021, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the UPPER90 FUTSAL ACADEMY SUMMER CAMP 2021 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 ACADEMY SUMMER CAMP 2021, 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 futsal.
Do you agree? *

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.
Please select the week(s) you would like to attend. *

Week 1 Week 2 Week 3 Week 4

UPPER90 FUTSAL ACADEMY SUMMER CAMP 2021 $ 200.00

Please select the number of week(s) you chose from above.

Quantity
Item subtotal: $ 0.00

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

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UPPER90 FUTSAL ACADEMY

UPPER90 FUTSAL ACADEMY SUMMER CAMP 2021

WEEK 2 : JUNE 21, 22, 23 and 24