Transylvania soccer

Registration
Printable Form

Wilton

YORKTOWN HEIGHTS Registration Form

CAMPER REGISTRATION

Name ----------------------------------------------Date of birth-----------------------------

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

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

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

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

2008 SUMMER CAMP

Please check the session(s) you will prefer

q Session 1-YORKTOWN HEIGHTS @ Community Center

(August 4^th to August 8^th 2008 from 9:00AM to 12:00PM)

q Session 2-YORKTOWN HEIGHTS @ Community Center

(August 11^th to August 15^th, 2008 from 9:00AM to 12:00PM)

Waiver of Liability/ Emergency Authorization

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