Form Summer Camps

2008 Summer Camps

Single Entry Form

Sign up for multiple weeks this summer and receive a $10 discount for each successive registered camp. Or register at least 30 days before camp begins and receive $10 off the Full Day price, or $5 off the price of Half-Day/Keeper Academy.

Cost: depends from the program you choose

Player Information:

First Name: Last Name: Age: Birthdate: Gender: T-shirt Size: Street Address: Apartment: City: State: Zip:

Parent Information:

First Name: Last Name: Phone: E-mail:

Date	Town	Field Location
Jul 07 - Jul 11	Amherst, NH	Stern Rd.
Jul 14 - Jul 18	Tyngsboro, MA	Lowell Vocational School
Jul 14 - Jul 18	Milford, NH	Hampshire Hill
Jul 21 - Jul 25	Wilton, NH	High Mowing School
Jul 28 - Aug 01	Hollis, NH	Hardy Field
Aug 4 - Aug 9	Manchester, NH	Rock Rimmon Park
Aug 4 - Aug 9	Merrimack, NH	Merrimack Valley School (High School Training)
Aug 11 - Aug 15	Londonderry, NH	West Rd.
Aug 11 - Aug 15	Hollis, NH	HBHS (High School Training)
Aug 11 - Aug 15	Tyngsboro, MA	Tyngsboro High School (High School Training)
Aug 18 - Aug 22	Hollis, NH	Hardy Field
TOTAL:
DISCOUNT:
AMOUNT TO BE PAID:

Medical Release Form

Health History:

Seizure Disorder Asthma Allergy Orthopedic Injuries or Disorder: Drug Sensitivity or Allergy: Chronic Medical Problems: Other Special Problems:

Medical Information:

Name of Family Physician: Phone: Medical Insurance Company: Policy Number:

In Case of Emergency Contact:

Name: Relationship to Player: Day Phone: Evening Phone:

Parent or Legal Guardian should complete the following:
I hereby certify that the above - mentioned Player is in good health and fully able to participate in all the activities Skill Check Soccer. I agree that Skillz Check Soccer and its directors will not be held responsible for any accident or loss to the participant however caused and hereby release Skillz Check Soccer from all claims or damages which may arise from any accident or loss.
I consent to have administrators of Skillz Check Soccer act on my behalf should any emergency arise, and hereby grand permission to said adminstrators to authorise medical attnetion recommended by a physician, nurse or hospital.

Full Name of Parent or Legal Guardian:

Date: / /

Refund Policy: No cash refunds; You will receive a credit for a future clinic