THE FC SOCCER ACADEMY

SUBMIT APPLICATION

APPLICATION INFORMATION:
PLAYERS NAME:
BOY OR GIRL?:
AGE ON JAN. 1st 2009:
CURRENT TEAM:
WHICH SESSION?:
Parental consent: I herby give my permission for my son/daughter named above to participate in The FC Soccer Academy Winter Soccer Clinic at the The Brewster Sports Center. In consideration of his/her being permitted to participate, I agree to hold harmless from any liability The FC Soccer Academy, FC Westchester Soccer Club, Brewster Sports Center and any instructor, coach, assistant coach, assistant instructor, officer, director, trustee, or agent of any of them. I attest and verify that my son/daughter is physically fit to participate and to play soccer. Refunds will only be made if you withdraw "before session begins." You must submit your cancelled check to obtain refund
EMAIL ADDRESS:   TEL. NO.