Spring Indoor Soccer Camp March 11th-15th 2019

Spring Break Indoor Soccer Camp

(Boys and Girls Ages 5-12)

Details

March 11th-15th 2019

9-3 PM

Extended PM Care Available

*LUNCH WILL BE PROVIDED
Player Information
Player Name: *

First Name Last Name
Date of Birth: *

Month Day Year
Gender: *

Male Female
School
Allergies *
Referred by:
Guardian Information

(This will be the primary contact with Memorial Indoor)
Parent Name *

First Name Last Name
Primary Phone *

- Area Code Phone Number
E-mail Guardian *

Services:

5 Day Spring Camp $ 250.00

March 11th $ 60.00

March 12th $ 60.00

March 13th $ 60.00

March 14th $ 60.00

March 15th $ 60.00

Extended Afternoon Hours (3pm-5pm) $ 30.00

Quantity

Total $ 0.00

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

What to Bring:

1. Indoor soccer shoes or tennis shoes

2. Shin guards

3. Water bottle

4. Snacks

* LUNCH WILL BE PROVIDED FOR OUR WINTER CAMPS (12-1pm)

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Memorial Indoor Sports Academy (MISA) during the selected class. In exchange for the acceptance of said child’s candidacy by MISA, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless MISA 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 activities.

In case of injury to said child, I hereby waive all claims against MISA 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.
I understand and consent to the medical waiver *

Yes
I understand and consent to the above release *

Yes
Should be Empty: