Pass & Dribble Summer Camp Registration Form

PASS & DRIBBLE SUMMER CAMP REGISTRATION

Athlete Information

Player Name

First NameLast Name

Date of Birth

Date

Gender

Mother/Guardian

First NameLast Name

Father/Guardian

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail

Soccer skill level

	1	2	3	4	5

1 is Begginer, 5 is Advanced

T-Shirt Size

Camp preference (Please list your first, second and third choices ONLY)

Important Notes

· Dress appropriately with shin guards.

· No food or drink in the gym or the turf field.

· Keep the gym and the turf fields clean.

. Refreshments (water, juice, chocolate milk and or gatorade) will be provided free of charge daily.

· Fee: $120 (cash, cheque - payable to 3CA or interac - finance@threeca.org) per participant.

. The camp organizers reserve the right to form the teams to ensure the age and talents of all campers are balanced.

Emergency Contact & Health Card Information

Emergency Contact's Name

First NameLast Name

Relationship

If selected 'other' please explain the relationship

Phone Number

Area CodePhone Number

Health Card Number

Does your child have any allergies, chronic illness, or medical conditions that would require modification of the program/activtiy?

Please describe

Release of Liability

Although the safety of all sport activities is the primary concern, indoor and outdoor sport activities at 3CA's facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and thus with my signature, I hereby release, discharge and/or otherwise indemnify the Organization (3CA), their employees and associated personnel and volunteers including 3CA facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs.

I also give the Organization permission to take and use photographs or recordings of Participant taken during an Activity and use and share such material for any purpose in print, advertisements, films or videos and on line and broadcast presentations of any sort

I have read and agree to the above conditions

Confirmation E-mail

Signature

Prove you are human