Soccer Program For TODDLERS

New Soccer Program For TODDLERS.

3 & 4 YEAR OLDS

BOYS & GIRLS

SEPTEMBER 5th – OCTOBER 17th ( 7 Training Sessions )
SATURDAY 9:00am – 10:30am

DAN WITT PARK
4521 NE 22nd AVE
LIGHTHOUSE POINT , FL 33064

COVID – 19 GUIDELINES MUST BE FOLLOWED
MANDATORY MASK FOR PARENTS AND SPECTATORS

SPACE LIMITED!!

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*
Parent / Guardian Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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
Registration
Price: $110.00
Please Note SEPTEMBER 5th – OCTOBER 17th ( 7 Training Sessions )
Credit Card

American Express
Discover
MasterCard
Visa
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