WORLD CUP SOCCER WINTER ACADEMY 2012
Player's Name
Player's Birthdate
Parent's Name    
Address    
     
City
Province
Postal Code    
       
Phone
Home Work Cell
Fax Attn Fax Number
E-mail
E-mail
Soccer Team (Club)
 
Coaches' Name Phone
Our Selection is:


BC Care Card Number
       
comments

As parent/guardian of the above named child I (we) understand the risks associated with the participation in the sport and specifically in this program. I (we) will not hold World Cup Soccer Camp Ltd. or its coaches responsible for any injuries arising from the participation in the above named program. In the event of a medical emergency I (we) give permission to the World Cup Soccer Camp staff to seek medical treatment if they are unable to contact us.

 

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Signature

World Cup Soccer Camp Ltd., 2780 West Shawnigan Lake Road, Shawnigan Lake, B.C. V0R 2W3

 

Registering is as easy as 1, 2, 3

  1. a copy of the registration form - ONLY PRINT PAGE 1
    HINT: If the right hand side of the form is cut off, click on File, Page Setup and set
    the left hand margin to 0, then print again.
  2. the registration form to World Cup Soccer Camp
  3. Send the Signed Registration form and payment to:

World Cup Soccer Camp Ltd.

2780 West Shawnigan Lake Road

Shawnigan Lake, B.C. V0R 2W3