2008 HALF-DAY HOLIDAY SOCCER CAMP APPLICATION

Fill out and mail with your check: (Please print clearly.)

Camper Name__________________________________ M___ F___ Age______

Address_______________________________________

City__________________________________________ Zip Code____________

Home Phone (     ) _______________ Business Phone (     ) _________________

Emergency Phone (     ) __________________  Email Address__________________________

Enroll me in Session:

Monday, March 31st ___ Tuesday, April 1st ___ Wednesday, April 2nd ___ Thursday, April 3rd ___ Friday, April 4th ___

Make checks payable to "PV Soccer" and mail to:
PV Soccer
C/O Bruce Myhre
706 Vincent Park, Unit 4
Redondo Beach, Ca 90277

I hereby authorize the staff of the Holiday Soccer Camp to act for me according to their best judgment in any emergency requiring medical attention. I hereby waive and release the camp from any and all liability for any injuries or illnesses incurred while at camp.  I have no knowledge of any physical impairment that would be affected by the above camper’s participation in the camp.  I will be responsible for any medical charges in connection with said camper's attendance at camp.

 

_____________________________________     ________________
Parent/Guardian Signature                              Date

For further information, please call Head Coach Bruce Myhre at:
(310) 798-6963 home
(310) 753-3321 cell
(310) 378-8471 x810 work