Toca Juniors FC Programs
Online Registration
 
TOCA Minis Soccer Program - Boys & Girls U4-7 (2012) Program information CLICK HERE
Registration/Waiver Form
Kid Full Name:
Date of Birth: Gender:
Parent Full Name:
Street Address:
City: State: Zipcode:
Session:
Full Session
Half Session
If your kid is not doing the full Camp, please let us know the weeks your kid will come to the camp :
Payment:
Paypal
Check
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 Minis soccer 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:
 
Session Cancellation Policy
Sessions might need to be cancelled due to the Park Athletic field inclement weather alerts. Since the program is based on the permit granted by the Park Athletic field permit request by which specific dates and times are assigned to the Toca Minis soccer training, when a specific session is cancelled, there will be NO re-schedule session.
 
Parent/Guardian Print Name:
 
Toca Continuity Soccer Program Refund Policy

• If the parent decides to opt out of the program 1 month prior to the Toca Minis soccer program started, he will be given 100% refund (May 18th is the deadline for 100% refund).
• If the parent decides to opt out the Soccer program between May 19th and June 10th a $75 Non-refundable fee will be charged.
• If the parent decides to opt out of the Soccer program June 11th and June 30th, then only 50% of the fee will be refunded.
• There is NO REFUND after July 1st. 2012.

Parent/Guardian Print Name:

 
 
[word format] Registration/Waiver Form

fill out and mail it to:
Toca Juniors FC
Att.: Fernando Cúneo
10109 Sterling Terr, Rockville, MD, 20850 , USA