PUTNAM VALLEY Registration Form

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2005 SUMMER CAMP – SLEEP OVER at PUTNAM VALLEY / NY

    Please check the session(s) you will prefer:

q       JULY 10 to JULY 15, 2005 ( Sunday 5:00 to Friday 5:00 PM)

  q       JULY 17 TO JULY 22, 2005 ( Sunday 5:00 PM to Friday 5:00 PM)

  q       JULY 24 TO JULY 29, 2005 ( Sunday 5:00 PM to Friday 5:00 PM)

  q       JULY 31 TO AUGUST 5, 05 ( Sunday 5:00 PM to Friday 5:00 PM)

   q       AUGUST 7 TO AUGUST 12, 05 ( Sunday 5:00 PM to Friday 5:00 PM)

Waiver of Liability/ Emergency Authorization

To induce the Town of Putnam Valley and Transylvania Soccer to accept registration and permit participation in the Town of Putnam Valley and Transylvania Soccer’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 Putnam Valley and Transylvania Soccer, their officers, directors instructors/coaches, and representatives from any claim out for injury out of the Town of Putnam Valley and Transylvania Soccer’s activities.

In case of emergency I hereby authorize treatment and care of player by any hospital, doctor, or emergency or ambulance association

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Transylvania Soccer camps

11 Grace Court

Bethel, 

CT -  06801