Registration

Please fill in the form below to secure a place for your child at Footskills. We will contact you directly to arrange payment. (All fields required. The $75.00 non-refundable deposit must accompany this application by June 1, 2016.)

STUDENT NAME *
AGE *
MALE FEMALE
WEEKS ENROLLED *
Week 1
Week 2
Week 3
Week 4
STREET ADDRESS *
TOWN *
STATE *
ZIP *
PARENT/GUARDIAN *
EMAIL *
HOME PHONE *
CELL PHONE
BUSINESS PHONE
EMERGENCY CONTACT
EMERGENCY PHONE

HEALTH & INSURANCE
Parents must advise us of any special health conditions or
medications taken by the child and submit their insurance
carrier's name and policy # for primary coverage.

INSURANCE CARRIER
POLICY #
I hereby certify that my son/daughter is in good health and able to participate in all camp activities. In case of emergency, I give permission to the trainer or coach of Footskills Soccer Camp to act for me according to his/her best judgement in any emergency requiring medical attention if I cannot be reached. I hereby waive and release trainer or coach of Footskills Soccer Camp from liability for injuries, illness or loss of property incurred while attending camp.
I accept these terms DATE //

(click here to download a print application)

ABOUT FOOTSKILLSDATES/FEESINSTRUCTORSDIRECTIONS/CONTACTREGISTRATION
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