Soccer In USA - Ascoli Coach Seminar Registration

Ascoli Coaches Seminar Registration

Please fill out the form below to register for Ascoli Coaches Seminar.

Participant 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 Adult SmallAdult MediumAdult LargeAdult X Large

Any notes to Ascoli

Medical Information

Medical insurance company

Medical insurance policy #

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

Doctor's name

Doctor's phone number

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., Ascoli Soccer Academy, its Agents, Coaches, and staff from all liability or damage, or legal action on behalf of the player or the player’s parents, heirs, or personal representatives arising from any injury the responsibility for any claim, player may sustain while participating in soccer or related activities. I hereby authorize the staff of the Ascoli Soccer Academy and 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. and Ascoli Soccer Academy retains any right to use in documenting the activities of the Tournament and/or trip, for educational and promotional purposes, photographs or video of campers taken during the trip and tournament. Ascoli Soccer Academy and 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.

Room Type and Payment

$2,410.00 for Triple Occupancy
$2,455.00 for Double Occupancy
$2,600.00 for Single Occupancy

We accept the following payment options: