Camp Sign Up

To sign up for a camp fill out the following form, print and follow the mailing instructions at the bottom of the page

Participants First Name

Participants Last Name

Address

City

State     Zip

Parent Guardian

Home Telephone

Grade Entering

Daytime Telephone

Email Address: 

Insurance carrier

Policy number

Physical Restrictions of participant:

Male      Female   

Camp Attending

Participants regular season team/s:

 

I verify that my child has been checked by a licensed physician and is physically able to participate in this sports camp.  I agree to allow my child to be treated by a licensed physician while attending, if necessary, and to assume related to such treatment.  I authorize my insurance company to pay benefits.  Also, I authorize the disclosure of medical information to my insurance company for the purpose of claim.  I hereby waive, release, and forever discharge Wisconsin Soccer Academy and its staff from any liability or claims arising out of any loss, personal injury or property damage that may occur during participation in camp.  I hereby certify that this participant is able to participate in all camp activities.  In case of emergency, I grant permission for my son or daughter to be given emergency treatment at a local hospital or medical facility.

X___________________________Date_____________
     Signature (Parent or Guardian)

 

Instructions Page

Please sign and date the waiver statement.  Please make all checks payable to Wisconsin Soccer Academy.

Mail Form and Check to:
6107 Spring Pond Ct
McFarland, WI  53558

 

If you are having problems printing the sign up form please click here.  A new window will open containing the sign up page.  After you have filled out the information click on file in the upper left had corner of the screen and then select print.