2010 APPLICATION FORM

 

Name:____________________________   (M) _____ (F) ______

 

Address: _____________________________________________

 

City: ____________________ State: ______ Zip: __________

 

Home Phone: (____) _______________

 

Email: __________________________

 

Cell/Other: (____) _________________

 

Date of Birth: ____/_____/_____ Age:______ Grade as of Sept. ’10: ___

 

Years Played: ________   Position:_________

 

Emergency Information:

 

Name: ____________________________________________

 

Home: ____________________________________________

 

Work: ____________________________________________

 

Camp:

□ College Elite Week (July 11 – 15th, 2010)

          □ Residential Camper ($ 500.00)

                   Roommate Preference___________________________

          □ Full-Day Camper ($ 400.00)

                   (9:00am – 8:00pm)

Discounts are available to teams and groups consisting of 12 or more players. Fee is $425.00 per player. All applications must be sent together.

 

A $150.00 non-refundable, non-transferable reservation deposit must accompany this application before or on June 1, 2010 (or you may send the full amount at once). Remaining balances must be paid in full by June 15, 2010. If applying after June 15, 2010, full payment is required. If a player, who has paid in full, withdraws or cancels before the start of camp, a $100 service fee will be withheld and the balance will be applied to next year’s camp fee. There will be no exceptions to this policy. Once we receive your application, your canceled check will secure your place. All checks should be made payable to Elvis Comrie Soccer Academy and mailed to:

 

ELVIS COMRIE SOCCER ACADEMY

PO BOX 211

BLOOMFIELD, CT 06002

 

GENERAL RELEASE:

I certify that the applicant is in excellent physical health and is capable of participating in strenuous physical activity, to with soccer. I further certify that I give permission for him/her to participate in the soccer camp being conducted by the Academy. I also agree to hold harmless the Soccer Academy camp, its staff, agents, Lawrence Academy, and employees from any and all injuries, which may be sustained by the camper during his/her participation in the camp. In case of an emergency, I grant permission for the applicant to be given treatment at local hospital.

 

PHOTO RELEASE:

I certify that the applicant’s photo and representation may be used in camp publications including brochures, websites, and videos. I understand the picture will be distributed publicly, both possibly on the brochure and/or on the website.

 

Mandatory (Parent) Signature: __________________________________

                                         Print: __________________________________

 



 

Resident and Full Day Campers (Please circle size below)

 

SHIRT SIZE    (ADULT)    M    L     XL

 

Full Day Campers ONLY (Please check box below)

 

BALL PURCHASE

I am purchasing an official CAMP BALL       □

(Please enclose payment of $25.00 for ball, with application)

 

                        SIZE #5

 

I will bring my own ball                                    □

 

*All campers must have a ball.

 

 

 

FOR OFFICIAL USE ONLY

Deposit __________

Day_________

Res________

Total Due ________

Check# ______

Date_______

Balance __________

Check# ______

Date_______

Ball _____________