Form Summer Camps

2008 Summer Camps

Sibling Registration

Register one child at full camp price and receive $5 off, of the rates for each successive child.

Cost: depends from the program you choose

Player 1 Sibling 1 Sibling 2 Sibling 3

Player Information:

First Name: Last Name: 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:

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: / /

Total amount for all siblings:

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