Soccer In USA - Ascoli Camp Registration

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	1/29/2012

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Ascoli Soccer Camp Registration

Please fill out the form below to register for Ascoli Soccer Camp.

Age Group

Boys 8-12 years of ageBoys 13-19 years of age

Player Information

First Name    Last Name

Gender

Birthdate (Month) (Day) (Year - 4 digit)

Address

City    State Choose 'Other' if outside US!

Zip    Country

Phone    Type

Email

T-shirt size Youth SmallYouth MediumYouth Large
Adult SmallAdult MediumAdult Large

Note to Camp Directors

Parent Information

Parent #1

First Name    Last Name

Email

Home Phone    Work Phone

Cell Phone

Parent #2

First Name    Last Name

Email

Home Phone    Work Phone

Cell Phone

Medical Information

Medical insurance company

Medical insurance policy #

List any medical concerns (allergies, asthma, e.g.)

Doctor's name

Doctor's phone number

Emergency Information

Emergency Contact Person #1

Name

Phone

Emergency Contact Person #2

Name

Phone

Release And Agreement

Release and agreement: I, the parent of the player named hereon acknowledge that participation in the sport of soccer, as in any sport, may result in injury. I hereby release Sports in USA, Inc., its Agents, Coaches, and staff from all liability or responsibility for any claim, damage, or legal action on behalf of the player or the player’s parents, heirs, or personal representatives arising from any injury the player may sustain while participating in soccer or related activities. I hereby authorize the staff of the Sports in USA, Inc. to act for me according to their best judgment in any emergency situation requiring medical attention. I give my consent for emergency medical care prescribed by a licensed doctor of medicine or dentistry. I, also, understand Sports in USA, Inc. retains any right to use in documenting the activities of Empoli Soccer Camp, for educational and promotional purposes, photographs or video of campers taken at camp. Sports in USA will NOT be responsible if it is unable to commence, continue or completely perform its obligations hereunder by reason of force majeure, fire, flood, hurricane, Tropical Storm, typhoon, aircraft damage, war, state of national emergency, local or USA Government action or any cause whatsoever (whether or not of similar nature to the forgoing) which is not within its control.

I agree to the above release and agreement.

RESPONSABILITY: The organization is responsible for the taking place of the activities of the camp chosen, under the condition that the activities are executed as directed by the camp instructors. The Ascoli Soccer Academy, during the period of the selected camp will not be in any way responsible for any damage; physical or not. Every participant has to follow all the rules of good education and respect of others.

IMPORTANT NOTE: Submission of an application and payment does not guarantee acceptance to the camp. Upon acceptance, a confirmation will be forwarded to you. If not accepted, your payment will be reimbursed in full.

CANCELLATION AND REFUNDS: In case of cancellation, the player or is tutor needs to send a Fax or letter before June 10th 2009 to Mare Events, Corp. 4265 Conway Place Crl, Orlando, FL 32812 or Fax: 407-251-6368. In the letter or fax it needs to be stated the decision to cancel, the first and last name of the player and the period previously selected. The Ascoli Soccer Academy and Mare Events will refund the amount of registration minus a $300 in penalty. All the cancellations received after June 10 2009 will receive no refund.

Camp Dates and Payment

$1,050.00 Ascoli Soccer Camp for ONE Week
$2,100.00 Ascoli Soccer Camp for TWO Weeks
$2,870.00 Ascoli Soccer Camp for THREE Weeks

1st Week: June 29- July 5 2009

2nd Week: July 6- July 12 2009

3rd Week: July 13- July 19 2009

Please indicate which week(s) you want to join the camp in the "Note to Camp Directors" under the Player Information section.

For instance, if you choose TWO Weeks, then you just type in "I want to participate in the 1st and 3rd week" in the Note to Camp Directors box.

We accept the following payment options: