Summer Futsal Camp

Step 1 of 2: Submit

Participant Name: Date of Birth:

Age Group Does the participant have any Illness such as asthma (if yes, please explain): Parent or Guardian: Home Phone: Cell Phone: Email Address:

Camp Fees: Half Day: 9:00am - 12:00pm - $135/week Full Day: 9:00am - 3:00pm - $195/week

Are you interested in after-camp care from 3:00pm - 5:30pm for an additional fee? Yes No

Please select the weeks to attend: Week 1: July 1st – 5th (Cedarbridge Academy Gym - this week only) Week 2: July 8th – 12th Week 3: July 15th – 19th (International Guest Week) Week 4: July 22nd – 26th Week 5: July 29th – July 31st (reduced fees) Week 6: August 5th - 9th

Pay By: Direct Deposit Cash Credit Card

Comments:

Participation includes possible exposure to and illness from infectious diseases including but not limited to influenza and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness does exist.

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for the participation; and,

I willingly agree to comply with the terms for participation in regards protection against infectious diseases. If, however, I observe and any significant hazard during my presence or participation, bring such to the attention of an official.

By submitting this form, you hereby agree that Footy Promotions / Footy Force Futsal Academy, its members, coaches or officers, shall not be liable for any and all illness, disability or injury

or loss which my child or children may sustain while participating in activities of any kind, whether sponsored by or under the supervision of the Footy Promotions / Footy Force Futsal Academy.

We agree to indemnify and to hold harmless Footy Promotions / Footy Force Futsal Academy, its members, coaches, officers or designates from any kind of claim whatsoever.

The Participant, and the Parent(s) or Guardian(s), if the Participant is a minor child, grant authorization to Footy Promotions / Footy Force Futsal

to use photographs and video of the Participant for publicity purposes including Website, social media and print advertising content.

Parent or Guardians Please Initial Here To Sign: Date:

Please note that there are no refunds once the participant has started the Summer Futsal Camp weekly sessions