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CAMPER REGISTRATION
Name ----------------------------------------------Birth
day--------------
Address---------------------------------------------------------------
Town----------------------------State------------------Zip----------
Home Tel-------------------------Emerg
Tel-----------------------------
E-mail------------------------------------------------------------------
2008 SPRING CAMP
Location: GRAFFLIN
SCHOOL (RT 120, Chappaqua)
April 21 to April 25, 2008
Time:
·
9:30 AM - 12:00
PM - 1/2 DAY
Waiver of Liability/ Emergency Authorization
To enable
the Town of New Castle, Chappaqua AYSO and Transylvania Gym & Soccer
LLC to accept registration and permit participation in the Town of New Castle, Chappaqua AYSO and Transylvania &
Soccer LLC’s activities by the above named player.
I player’s parent /guardian, hereby give my consent to his /her participation
and agree to release, indemnify, and hold harmless, the Town of New
Castle, Chappaqua AYSO and Transylvania Gym & Soccer LLC, their officers,
directors instructors/coaches, and representatives from any claim out of the Town
of New Castle, Chappaqua AYSO and Transylvania
Gym & Soccer LLC’s activities.
In
case of emergency I hereby authorize treatment and care of player by any
hospital, doctor, or emergency or ambulance association.
--------------------------------------------------------------------------------------------------------------------------------
Parent /guardian
Signature Date
Transylvania Gym & Soccer LLC
11 Grace Court, Bethel,
CT - 06801
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