| Pantuosco's
Soccer Camp Application 2007 |
Name:
Both First & Last Names |
Age:
|
| Address: |
M: F: |
| Town: |
Grade in
September: |
| Zip Code: |
State: |
Home Phone:
|
Emergency Phone:
Must Be Different than Home Phone Number |
Email:
|
Team Name:
Only if applicable for team discount (6+ players) |
|
|
| T-Shirt Size: |
Youth |
10-12 |
14-16 |
| Check all that
apply
|
Adult |
S |
M |
L |
XL |
|
|
| Select the week or weeks you wish your child to
attend: |
| Please check all that apply: |
| Jewish Community Center: |
6/23
Pee-Wee |
6/30
(4-Day)
Pee-Wee |
|
| Williams Middle School: |
7/7 |
7/14 |
| Cathedral
High School: |
7/28 |
|
Trans.
from CT (7/28) |
|
Trans.
from Agawam (7/28) |
|
8/4 |
|
|
Trans.
from West Springfield (8/4) |
|
Goalkeeper
(8/4) |
| Premier Camp: |
8/4-7
@ Cathedral |
| Varsity Camp: |
8/11-14
@ Cathedral |
|
Click here for the MEDICAL FORM
Please mail
medical form Already
downloaded medical form |
|
Release
|
| I
fully recognize and appreciate the dangers and hazards involved in
soccer camp and do hereby agree to assume all risks and responsibilities
surrounding my child(ren)'s participation at camp, and further, do
hereby release and hold harmless, Pantuosco's Pioneer Valley Soccer
Camp, Inc.; Joe Pantuosco; employees; participants; owners and lessees
of premises used for soccer camp against any and all liabilities. I
understand that Pantuosco's Soccer Camp and the aforementioned parties will not assume any responsibility for
accidents and medical or dental expenses incurred as a result of
participation in the program, whether caused by the negligence of
Pantuosco's Soccer Camp or persons acting on its behalf or otherwise. I
am responsible for
providing medical insurance for my child(ren). The applicant is
in good health and able to participate in the physical activities of a
vigorous program. |
I have read and understand this release and voluntarily allow my
son/daughter to participate in Pantuosco's Soccer Camp.
|
Parent / Guardian Signature:
|
|
|
|
|
By submitting this application you are
agreeing to the above statement and are also required to mail in a $50
NONREFUNDABLE DEPOSIT
made payable to Joe
Pantuosco, for each camper enrolled with PSC.
If you wish you may print the application in .pdf format, complete it by hand, and mail it
to:
PSC, 18 Greenleaf Dr. Hampden, MA, 01036
If you experience any difficulties using this feature of our website,
please contact pantuosco@hotmail.com
|