Toca Juniors FC Programs
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TOCA Continuity Soccer Program
SUMMER CAMP 2017

Improving skills, making friends & staying fit
Girls & Boys (Ages 5 to 19)


Registration/Waiver Form
Camper Full Name:
Gender:
Date of Birth:
Parent Full Name:
Street Address:
City: State: Zipcode:  
Program:
 
 
Ages 5 to 8
Returning Members
New Members
 
Ages 9 to 19
Club Members
Non Club Members
 
Session:
Full Session
Half Session
 
If your kid is not doing the full Camp, please let us know the days your kid will come to the camp :
Payment:
Paypal
Check
Please indicate how you heard about Summer Soccer Camp:
Friend
Website
Social Media
Email Marketing
Flyer
If is other please specify:
Primary Email:
Alternate Email:
Home Phone: Cell:
Questions?!::
 
Medical Treatment Authorization and Liability Waiver
• I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the player listed below with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the player listed above to a medical treatment facility should an individual listed above consider it to be warranted.
• I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, Toca Juniors FC, Coaches, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in Toca training Program and/or being transported to or from the same, which transportation I hereby authorize.
• I understand that I am required to have accidental medical coverage for the child listed on this waiver, and I verify that the information provided on this form is accurate and true. I understand and agree that if I do not have accidental medical coverage for the child listed on this waiver, I will be financially responsible for all charges and fees incurred in the rendering of said treatment.
• I understand that at the discretion of the camp coach and staff my child may be dismissed from the camps without refund for inappropriate behavior.
• I understand that at the conclusion of the scheduled camp time the program and staff are no longer responsible for my child.
 
Relation to player (choose one):
Father
Mother
Guardian
Signature Date:
Parent/Guardian Print Name:
Insurance Company:
Policy Number:
Emergency Contact:
Phone Number: