Our Savior Spring Soccer League

The camp is available to anyone ages 5 to 13 years old. (Kindergarten through 8th Grade.)

The Soccer training meets on Thursdays and Saturdays each week, March 16th through May 13th. You can sign up for one day or both days below.

Location:

Our Savior New American School

140 Mark Tree Road

Centereach, NY 11720

If you have any questions contact Paige Jelinek: paige.jelinek@osnas.org or (315) 427-0114

Child Information:

Child's Last Name*

Child's First Name*

Gender

MaleFemale

Parent Information:

Parent First Name*

Parent Last Name*

Parent Street Address*

Parent Street Address 2

Parent City*

Parent State*

Parent Zip Code*

Parent Email*

Parent Daytime Phone*

Parent Cellphone*

Emergency Contact Information

Emergency Contact First Name*

Emergency Contact Last Name*

Emergency Contact Phone 1*

Emergency Contact Phone 2*

Alternate Pickup First Name

Alternate Pickup Last Name

Alternate Pickup Phone

Additional Information

How did you hear about this Soccer League?

Does the child have any health, medical, food allergies, etc. that we should know about?*

To whom may the child be released to?:*

Medical Information

Allergies:

Medical Issues or Special Needs:

Medical Release:

I give my permission for the Our Savior Soccer League Staff (further called Staff) to administer basic first aid to my child (named above) in the event of an injury. I understand that the Staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Media Release:

I hereby grant my permission for the Staff to copyright and use photographs / videos taken at the Soccer League of the minor designated above in any manor or form for any purpose lawful at the time. I waive my right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

Permission to Attend:

I give my permission for my child (named above) to attend the Soccer League listed above. I understand that the information I give for this registration will only be used by the League hosting church and school.

*

Permission Granted to All Three Above

Our Savior Soccer Training Terms and Conditions:

My child is phyisically fit to participate in this activity. I understand that I am responsible for any medical expenses, hospital, laboratory, and doctors fees. Please do not send your child if they are not feeling well.

By selecting the "I agree to the terms and conditions" checkbox, you are signing this Agreement electronically and consent to be bound by its terms and conditions.

*

I agree to the terms and conditions.

*

Signature

Please Select One of the following:*

Thursdays and Saturdays

$350.00

Thursdays Only

$200.00

Saturdays Only

$200.00

Total

$0.00

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.