Step 2 of 3

PLEASE COMPLETE THE APPLICATION BELOW TO REGISTER YOUR CHILD - THIS APPLICATION MUST BE COMPLETED NOW, OTHERWISE YOUR CHILD WILL NOT BE REGISTERED - FOR MULTIPLE CHILDREN, PLEASE FILL SEPARATE APPLICATIONS.

CARLOS OLIVEIRA SOCCER ACADEMY PARENTAL RELEASE STATEMENT

I/We the undersigned hereby certify that I (we) am (are) the parent (s) or legal guardian (s) of the camper. I (We) hereby give permission for the Camp to seek appropriate medical attention for the camper and for the medical attention to be given and for the camper to receive medical attention in the event of accident, injury or illness. I will be responsible for any and all costs of medical attention and treatment, except for that covered by the camper’s excess medical coverage policy. I/We, undersigned for ourselves our heirs, executors and administrators waive, release and forever discharge Carlos Oliveira Soccer Academy and its staff, officers, agents, employees, representatives and successors and assign of and from rights and claims for damages, injury or loss to person or property which may be sustained or occur during participating in Camp activities or while at Camp, whether or not damages, injury or loss is due to negligence. I/We hereby acknowledge that our child is physically fit mentally capable of participating in soccer camp activities.

Child's name:

Parent name:

Address:

City/State/Zip code:

Phone (home):

Phone (work):

e-mail:

Age:

male:

Female:

T-shirt size: Small | Medium |
Large | Extra Large | XXL

Check the appropriated section:

CHOOSE OPTION BELOW BASED ON PROGRAM ABOVE:

NEW: Winter break soccer camp at PS 9/PS 334
(February 19th through 22nd)

Winter 2007/2008 Program :

Choose Location:

for PS 9 Saturdays 7-9 Years old ONLY, please choose:

Choose group: (Change if different)

I am sending payment check by mail:

I have read and agreed with the Parental Release Statement above:

YOUR INITIALS HERE

Subject	Do NOT change it

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