Print and send to 1005 N. Geddes St. Syracuse, NY 13204
Syracuse Soccer Academy
Camp Registration Form
315-863-3322
Player’s Name ___________________________
Parent’s Name_____________________
Address _______________________________
City/State/Zip ____________________________
D.O.B. _____________Current Grade _________
E-Mail (Mandatory) ________________________
Day Phone ( ____ ) ________________________
T-Shirt Size: YM YL AS AM AL AXL
Payment Amount:____________Check#________
Cost: All day Camp $139.00 per camper and this includes a T-shirt
Ages: 5-12 Boys/Girls Camp Times: 9:00-4:00Camp Location: 1005 N. Geddes St.
Camp Dates: Aug.8-12-2011
Cost: Pre-Season High School Camp $115.00 per camper and this includes a T-shirt
Ages: 13-17 Boys/Girls Camp Times: 5:30-8:30 pm Camp Location: 1005 N. Geddes St. Camp Dates: Aug. 15-19-2011
In Consideration of this player’s participation in the soccer programs and
activities offered, I, for myself and the player and our respective heirs and
successors, intending to be legally bound, hereby release and indemnify
“Syracuse Soccer Academy”, Tony Epifani and any of their employees,
agents and representatives from and against all claims, liabilities,
damages or cause of action arising from the player’s participation in
the programs offered without limitation. Further, I acknowledge and
understand that the physical activities offered involve the risk of serious
injury, and severe social or economic losses may unavoidably result from
the rules of play, or from the negligence of the player or other players. I
hereby give my consent to Camp organizers and their agents to provide
my child with any reasonable and necessary emergency medical care
and agree to be financially responsible for all such emergency care.
Must be signed by a parent or legal guardian.
Signature of Parent/Guardian:________________________
Date: ___________
Syracuse Soccer Academy
Camp Registration Form
315-863-3322
Player’s Name ___________________________
Parent’s Name_____________________
Address _______________________________
City/State/Zip ____________________________
D.O.B. _____________Current Grade _________
E-Mail (Mandatory) ________________________
Day Phone ( ____ ) ________________________
T-Shirt Size: YM YL AS AM AL AXL
Payment Amount:____________Check#________
Cost: All day Camp $139.00 per camper and this includes a T-shirt
Ages: 5-12 Boys/Girls Camp Times: 9:00-4:00Camp Location: 1005 N. Geddes St.
Camp Dates: Aug.8-12-2011
Cost: Pre-Season High School Camp $115.00 per camper and this includes a T-shirt
Ages: 13-17 Boys/Girls Camp Times: 5:30-8:30 pm Camp Location: 1005 N. Geddes St. Camp Dates: Aug. 15-19-2011
In Consideration of this player’s participation in the soccer programs and
activities offered, I, for myself and the player and our respective heirs and
successors, intending to be legally bound, hereby release and indemnify
“Syracuse Soccer Academy”, Tony Epifani and any of their employees,
agents and representatives from and against all claims, liabilities,
damages or cause of action arising from the player’s participation in
the programs offered without limitation. Further, I acknowledge and
understand that the physical activities offered involve the risk of serious
injury, and severe social or economic losses may unavoidably result from
the rules of play, or from the negligence of the player or other players. I
hereby give my consent to Camp organizers and their agents to provide
my child with any reasonable and necessary emergency medical care
and agree to be financially responsible for all such emergency care.
Must be signed by a parent or legal guardian.
Signature of Parent/Guardian:________________________
Date: ___________