| PLEASE CLICK THE FOLLOWING SESSION(S) ATTENDING: |
June 20-24, 2011
June 27-July 1, 2011
July 11-15, 2011
July 25-29, 2011
Aug 1-4, 2011 (Signature & Club Players only) |
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| New or Returning:
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| CAMPER INFORMATION: |
| *ALL FIELDS MUST BE COMPLETED |
| Name (First & Last):
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| Age:
5 to 13 years old |
| Date of Birth:
1/12/1994 |
| Gender:
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| Skill Level:
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| Player Level:
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| PARENT/GUARDIAN INFORMATION: |
| Name (First & Last):
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| Address:
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| City:
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| State:
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| Zip:
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| Home Phone:
(ex. 714-123-1234) |
| Day Time Phone:
During Camp Week |
| Email:
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| Emergency Contact:
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| Emergency Phone:
Ext.
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| Medical Insurance Provider:
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| Please note any medical conditions that we should be aware of. If none, please state none. |
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| How did you hear about camp?
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| T-Shirt Size:
T-Shirts are Hanes 50/50 |
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Registration Fees:
Half Day (9am-12pm): $110 (after 6/6 $135)
Full Day (9am-3pm)$150 (after 6/6 $175) |
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| Special Instructions: |
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On behalf of the participant named on this application, for myself and all others, the undersigned parent or guardian, agrees to release indemnify all persons and entities including Chapman University, Orange High School, the City of Orange and City of Anaheim and their agents, employees, officers or other operatives, from any and all claims for liability of any type or nature (including personal injury) whether directly or indirectly caused in whole or in part by the releases just named, arising out of or in connection with activities conducted by the Panther Soccer Camp, and further assumes any and all risk of injury to the participant occasioned thereby. I hereby authorize the Directors of the Panther Soccer Camp to act for me according to their best judgment in an emergency requiring medical attention. The camp also reserves the right to use for publicity & advertising purposes, photographs taken during camp activities.
By submitting this
application to Panther Soccer Camp, I affirm that I have read and
agree to the Camps cancellation policy and hereby accept the terms of
enrollment described above. Furthermore, I agree to pay all camp fees and
authorize Panther Soccer Camp to charge my credit card. Credit card charges will show on your statements as "Panther Soccer Academy."
Camper cannot attend
camp without this form. |
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