Camp Registration

Player Information
First Name
Last Name
Birth Date (mm/dd/yyyy)
Gender
Street Address
City
State
Zip
Voucher:
What club are you affiliated with or N/A:
What level of soccer do you currently play:
How did you hear about the Silverbacks soccer camps?
T-Shirt Size

Family Contact
First Name
Last Name
Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)
Email:
Relationship to Player

Emergency Contact
First Name
Last Name
Cell Phone (XXX-XXX-XXXX)
Relationship to Player
Please list anyone else approved to pick up your child:
Insurance
Policy Holder
Policy Number
Allergies
List any Medical Conditions:
Is your family a 2012 Atlanta Silverbacks Season Ticket Holder?

Your are registering for the following camp:
Camp Location Suwanee Indoor
Camp Name 7/01 - 7/05: Multi Sports Camps - Week 6 - Movies (4 days)
 

WAIVER AND RELEASE OF LIABILITY: In the case of medical emergency I hereby give my permission to Atlanta Professional Soccer LLC and/or its agents to secure medical treatment of my child. The person enrolling in the camp, his/her parent or parents, or legal guardian assumes all risk of loss of property or injury to that person. This includes injuries that result in death caused by, or, incidental dangers associated with soccer activities. I/we agree that there are certain inherent dangers related to soccer participation and therefore agree to hold the Atlanta Silverbacks, its owners, officers, directors, managers, employees, and agents of the foregoing harmless, and specifically agree not to make claim against the Atlanta Silverbacks, InterMilan or any of their affiliated entities. The undersigned hereby certify that I(we) am(are) the parents or legal guardian of the camper.

 

By entering your name below, you are indicating you agree with the statement above.

 
Your Name:
 

Submit Camp Registration

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