Fast Feet - Summer Soccer Camp Registration

PLAYER INFORMATION

First Name :
Age :
Gender : Male Female

Last Name : Date of Birth :
T-Shirt size:

PARENTS INFORMATION

Home Address :

City : Zip : Home Number:

Mother's

First Name : Last Name :

Mobile Phone : Email :

Father's

First Name : Last Name :

Mobile Phone : Email :

SOCCER INFORMATION

Week : Week 1 Week 2

I acknowledge that I have read and fully understand the BTSA medical release and waiver.
(View waiver/medical release)

Fast Feet Medical Release and Waiver

As parent or legal guardian of the above named player, I hereby authorize any first aid or emergency medical care prescribed by a duly licensed physician, dentist or other qualified medical personnel acting under their supervision, that may become necessary to preserve the life, limbs or well being of my dependent, while he/she is taking part in the Fast Feet Summer Soccer Camp.

in consideration of the acceptance of my child's/ward's entry into the Fast Feet Summer Soccer Camp, I hereby, for myself and my child/ward, or heirs, executors, adminstrators and personal representatives, discharge, waive and release Jerry Shutway, Fast Feet Summer Soccer Camp, the Brechsville Travel Soccer Assoiciation, its coaches, officers, employees, and agents in the event of injury or death, which my child/ward or I may have by virtue of or asising in connection with his/her participation in the soccer program. By executing this document I hereby assume, on behalf of my child/ward, all risk of injury or loss to which he/she may be exposed both during the program as well as in transit to and from the program.

I also give permission for the free use of my child's/ward's name, picture, and/or likeness in any article, broadcast or other account of the Fast Feet Summer Camp.