DELAWARE SOCCER CAMPS 2010 TEAM Camp Registration and Medical Form
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Grade Fall (2010)
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Comments or Special Requests
TEAM CAMPS OFFERED: We will be offering 2 weeks of team camps this year. REP/TRAVEL TEAM camp will be for boys and girls from 9-14 years and it will be held at the University of Delaware Sports Complex. This camp will be offered at 2 separate times 9am-12pm or 5pm-8pm each day. Please note the time you prefer below. We will also offer the HIGH SCHOOL BOYS PRE-SEASON TEAM CAMP which will be offered to high school age boys only and will be held at the Kirkwood Soccer Complex. This camp is designed for teams of 8 players or more. The group will train in 2 hour increments each day with Coach Hennessy. The available times for this camp are 8:45am-10:45am, 11am-1pm, 1:45pm-3:45pm, 4pm-6pm and 6:15pm-8:15pm. Please note the time the team has agreed upon below.
REP/TEAM CAMP TIMES
9:00am-12:00pm
5:00pm-8:00pm
HIGH SCHOOL BOYS CAMP TIMES
8:45am-10:45am
11:00am-1:00pm
1:45pm-3:45pm
4:00pm-6:00pm
6:15pm-8:15pm
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REP/Travel Team Camp 8/2-6/10
$125.00
$
125.00
REP/Travel Team Camp w/ Multi-Week or Sibling Discount
$115.00
$
115.00
BOYS High School Camp 8/10-14/10
$125.00
$
125.00
BOYS High School Camp with Multi-Week or Sibling Discount
$115.00
$
115.00
Total
$0.00
$
0.00
***CHECK BELOW IF SUBMITTING A CHECK BY MAIL ONLY!***
TEAM CAMPS - Check desired camp
REP/TRAVEL CAMP: 8/2-6/2010
BOYS HS CAMP: 8/10-14/2010
Discounts Offered: Choose if applicable
$10 Multi-Week (off 2nd week)
$10 Sibling Discount (off each child)
** Discounts cannot be combined
Online registration requires full payment at time of registration. Any cancellations will incur a $75 application fee. If paying by check a $75 non-refundable deposit is due at the time of registration. Full payments are due by July 1, 2010. Registrations after July 1, 2010 will require full payment.
Medical and Contact Information Required
Mother's First Name
Mother's Last Name
Mother's Day Phone
Mother's Cell Phone
Father's First Name
Father's Last Name
Father's Day Phone
Father's Cell Phone
IF PARENTS/GUARDIANS CANNOT BE REACHED, PLEASE CALL THE FOLLOWING:
Emergency Contact #1 Name/Phone Number
*
Emergency Contact #2 Name/Phone Number
Family Physician Name
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Family Physician Number
*
IN THE BOX BELOW, PLEASE EXPLAIN ANDY SERIOUS MEDICAL CONDITIONS AND LIST THE NAMES OF ANY MEDICATIONS THE CAMPER IS PRESENTLY TAKING AND FOR WHAT MEDICAL CONDITIONS
Allergic to
Penicillin
Aspirin
Latex
Other Allergy
Medical Insurance Company
Policy Number
Are you insured by any other health benefit plan such as an HMO. Please specify
The above Camper has been examined within the last 12 months and no medical reason has been found that he/she can not participate in this camp. Records show that all immunizations are up to date.n
I agree that In case of an accident involving my child while attending camp and with full awareness that soccer is an activity that may involve risk or injury, I release Delaware Soccer Camps and the University of Delaware from any and all liability. In case of an emergency, I give permission to have my child properly transported to a medical facility for care. I understand that Delaware Soccer Camps and the University of Delaware do not provide medical insurance and that I will be responsible for all medical expenses incurred. Delaware Soccer Camps has established the following procedure for injury or sickness: (1) the camp will call home. (2) call the father’s, mother’s or guardian’s place of employment, (3) call the emergency numbers and physician, (4) call an ambulance if necessary for transportation to medical facility, (5) attending physician will make judgment of admittance, (6) Delaware Soccer Camps will continue to call parents , guardian or physician until one is reached. If I cannot be reached and the camp has followed the above procedures, I assume all expense for the transportation and medical treatment. I also hereby consent to any treatment, surgery, diagnostic procedure, or the administration of anesthesia which may be carried out based on the medical judgment of an attending physician.
Medical Waiver
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I Agree to the terms detailed above
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