http://www.2xsoccer.lu/

REGISTRATION FORM

Registering For (The Camp Name):

Camp Lunch (YES or NO):

Player First name:

Player Last name:

School:

Date of birth:

Age:

Height:

Mother name and GSM:

Father name and GSM:

Address:

City:

Post-Code:

Home telephone:

E-mail:

IN CASE OF EMERGENCY CONTACT

Name:

Telephone:

GSM:

MEDICAL / ALLERGIES, OTHER INFORMATIONS

Status:

Thank You And Have Fun !

All our programs runs under this rules:

1) I hereby certify that my child has my permission to attend “SOCCER-SOCCER" Academy camp.

2) If at any time emergency medical treatment is necessary for my child, I give my consent for treatment to be given.

3) Every effort will be made to contact parent guardian.

4) I hereby agree to release and indemnify "Soccer-Soccer" Academy, instructors and members from any actions claims, or injury that my occur.

5) I hereby agree to use my own medical insurance for cower any injuries of my son/daughter during the training sessions in "Soccer-Soccer" camp.

6) "Soccer-Soccer" Academy is not responsible for any loss or damage of personal property of any participants.

7) Parents / guardian signature:

_______________________________________

"GLOBALPRO"

Soccer-Soccer

Elite Football Academy

14 rue Andre Duchscher, L-1424 Luxembourg

Office: (352) 24 87 35 36

Fax: (352) 24 87 35 37

GSM: (352) 621 515 195