Winter Camp

2020 Winter Break Soccer Camp

Week 2

December 28, 29 & 30.

For Boys & Girls
Age 5-12
Half Day 9:00am – 12:00pm $115/3 Days

Location:
Patch Reef Park

2000 W Yamato Road
Boca Raton, FL 33431

Picture Upload
Accepted file types: jpg, png, pdf.
Please Provide a Picture of the Player:
Player's Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
December Camp*
- December 28,29 & 30
Parent / Guardian Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Signature
Date
Date Format: MM slash DD slash YYYY

Medical Release Form
Emergency Contact*
First Last
Phone*
Allergies*
Medical Conditions*
Physician's Name*
First Last
Physician's Phone*
Medical Insurance Providers*
Insurance Policy Holder's Name*
Policy Number*
Insurance Provider Phone Number*
Saint Andrew's School and Camp maintain privacy over your child's health information. In accordance with this policy, access to all health information is limited to the nurse, counselors and administrators and is only utilized for the safety and protection of your child or in an emergency.
The parents consent to medical treatment by the camp nurse as needed as well as transportation to the closest hospital in the event of an emergency by ambulance. All efforts will be made to contact the parents in the event of an emergency.
Signature

Payment Form
Training Soccer Camp
Price: $115.00
Half Day 9:00am - 12:00pm, 3 Days
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Credit Card

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Card Number Expiration Date Security Code Cardholder Name
*
- Upon checking this box, you will be providing Colo Colo Soccer Academy USA with valid and updated credit card information. If you provide your credit card information to Us, You authorize Us to charge such credit card for all Purchased Services, including Registration Fees, or Ongoing Training Fees. Early termination from Training Fees requires a written notice to colocolosoccerusa@gmail.com 30 Days in Advance.

Medical Release Form