through Ruedi Graff’s
World Cup Soccer Camps
Date and Time Location Team Name
‡ July 11-15, 2005
Time:
9:00-3:00* ‡ ‘93G Typhoons
‡ July 25-29, 2005
Time:
9:00-12:30* ‡ ’95G Green ***
‡ August 1-5, 2005
Time:
9:00-3:00*
‡ August 8-12, 2005
Time:
9:00-3:00* ‡ ‘95G Gryphons Red
* Goalie camp is each day
from 8:00-9:00.
*** Camp for the ‘95G Blue and Green teams
is half day. Cost for the half-day camp
is $150. Full payment is needed at time
of signing up.
TO REGISTER: Complete this form and
return it with a nonrefundable $125.00 deposit per child. Return to your SAYSO
team manager in the player’s fall SAYSO registration packet by May 31. Mail the $125 balance before the 1st
day of camp to: World Cup Soccer Camps,
If paying by Visa or
MasterCard, full amount will be charged and is nonrefundable:
Charge my
(circle) Visa MasterCard Cardholder's Name
_________________________
Account Number:
__ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Exp. __ __- __ __
Player’s
Name__________________________________________ Boy_______ Girl_______
Parent(s)
Name_____________________________________
E-Mail :______________________________
Address___________________________________________City_____________________Zip_____________
Mom’s Cell
Phone_______________ Dad’s Cell phone
__________________ Emergency Phone_____________
Medical
Considerations/Limitations. List if player will have a prescription
inhaler to use as needed. ____________
Parental consent: I, _____________________, grant my
child, _____________________, permission to participate in the World Cup Soccer
Camp scheduled for (date) ____________________. I understand that soccer
activities are of a strenuous nature that does pose some risk of injury. As
parent/guardian, I waive all claims of liability against World Cup Soccer
Camps, its directors, employees and the cities of
Insurance Carrier
________________________________ Policy # _______________________________