THE FC SOCCER ACADEMY

SUBMIT APPLICATION

APPLICATION INFORMATION:
PLAYERS NAME:
WHICH SESSION?
AGE ON JANUARY 1st, 2010:
CURRENT TEAM:
Parental consent: I herby give my permission for my son/daughter named above to participate in The FC Soccer Academy training at 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. Full refund will only be made if you withdraw "before session begins." You must submit your cancelled check to obtain refund. If a player cannot attend for any medical reasons, upon presentation of a doctor;s note, the tuition less $100 admin fee will be refunded. The FC Soccer Academy reserves the rights to use individual pictures for publicity purposes.
EMAIL ADDRESS:   TEL. NO.
Mandatory Parent's Signature:   Today's date: