Asante Summer Camp Registration Form

Asante Summer Camp Registration
Campers Information
Campers Full Name*

First NameLast Name
DOB

MonthDayYear
Age*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number*
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the camper prescribed an inhaler? If yes, please explain any instructions.*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Asante Soccer Academy during the March Break Camp. In exchange for the acceptance of said child’s candidacy by Asante Soccer Academy. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Asante Soccer Academy. 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 Asante Soccer Academy. 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.
Waiver for Camper
I herby register my child and I do understand that there is a potential for injury while participating in the programs offered by your club and I agree to hold harmless Asante Soccer Academy (ASA), The Team, Officials, League, or District Associations from any and all injuries sustained while playing for ASA at practice, games, camp or events.*

I Agree
I agree to supply my child with soccer shoes and shin pads to be worn at all times during play and practices.*

I Agree
I agree to abide by the rules and regulations of Asante Soccer Academy, the Ontario Soccer Association and the North York Soccer Association.*

I Agree
I consent to my child being publicized, filmed, audio taped, photographed, interviewed by employees. agents or servants of ASA.*

I Agree
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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PAYMENT

Payment can be made by etransfer to kofibaah16@hotmail.com or by cash. Please note your child's spot will not be guaranteed until FULL PAYMENT has been received.
Should be Empty:

Asante Summer Camp Registration

Campers Information

Waiver for Camper

PAYMENT