Camp Registration Form

Football Camp Registration
Childs Information
Childs Name

First NameLast Name
Birth Date

DayMonthYear
Gender
Footballing Level (For Age)
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Mobile Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Has your child been prescribed an inhaler? If yes, please explain any instructions.
Booking dates
What Camp are you booking?
Week Beginning

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
2nd Week Beginning

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
3rd Week Beginning

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Bookable Days
prevnext( X )
Monday
£15.00 Quantity



Tuesday
£20.00 Quantity



Wednesday
£20.00 Quantity



Thursday
£20.00 Quantity



Friday
£20.00 Quantity



Full Week
£80.00 Quantity



Total

£0.00
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by FIVES Soccer Centres during the selected camp. In exchange for the acceptance of said child’s candidacy by FIVES Soccer Centres., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless FIVES Soccer Centres. 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 FIVES Soccer Centres . 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 Football. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Pictures and/or videos may be taken during the course of the camp activities for media and marketing reasons. If you do not consent to your child being photographed or filmed during the camp activities you must infrom us in writing prior to the start of the camp. To do this you can email in to hamilton@football5s.com.
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
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Football Camp Registration

Childs Information

Booking dates

Bookable Days*

Bookable Days