"Get Back On Your Game"
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Registration Form Name: __________________________ Address: ________________________ _________________________________ Telephone No: __________________ Age: _________ Boy Girl Please send $40 check or money order made payable to Penn Hills Boys Varsity Soccer Boosters by July 16, 2010. Mail completed registration form, signed release form and camp fee to: Penn Hills Boys Varsity Soccer Boosters Attn: MJ Gula 5832 Heberton Dr Verona, PA 15147 gmaapa@aol.com Parental Liability Release I/We the undersigned parents(s) or guardian of ______________________________ (Name of Child) do hereby grant my/our permission to participate in the Penn Hills Boys Varsity Soccer Camp entitled “Get Back on Your Game” during the week of August 11, 2009 through August 14, 2009 at Dible Soccer Fields in Penn Hills. I/We agree to indemnify and hold harmless the Penn Hills Soccer Association, all Penn Hills Boys Varsity Soccer Players, Coaches and Booster parents conducting the camp, and the Penn Hills School District where the camp will be held and any/all participants. I/We agree that in case of injury to my/our child, I/We will apply my/our hospitalization and/or accident insurance toward the payment of any expenses incurred and will not lay claim against any of the above named parties. ________________________ ________________________ Father/Legal Guardian Signature Mother/Legal Guardian Signature |
