2006 SOCCER CAMP @ DANBURY / PARK AVENUE SCHOOL

 CAMPER REGISTRATION FORM

Name ----------------------------------------------Age--------------

Address---------------------------------------------------------------

Town----------------------------State------------------Zip----------

Home Tel-------------------------Emerg Tel-----------------------

E-mail------------------------------------------------------------------

2006 SUMMER CAMP    q       Session 1-DANBURY-Park Avenue School

                          August 7 to August 11, 2006 

From 4:00 PM to 7:00 PM (PLEASE SEE THE SCHEDULE WITH TIMES DEVIDED FOR EACH AGE)

Waiver of Liability/ Emergency Authorization

To induce the Town of DANBURY and Transylvania Gym & Soccer LLC to accept registration and permit participation in the Town of DANBURY and Transylvania Gym & 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 DANBURY and Transylvania Gym & Soccer LLC, their officers, directors instructors/coaches, and representatives from any claim or liability involving any injury to the above player out of the Town of DANBURY 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