| Name | |
| Address | |
| City | |
| State | |
| Zip | |
| E-mail Address | |
| Home Phone # | |
| Business Phone # | |
| Club Affiliation | |
| T-Shirt Size | |
| Age at time of camp | |
| Sex | |
| Field Camp Goalkeeping Camp | |
| Method of Payment | |
| Parent / Guardian | |
| July 20 - 24 , 2009 | Half Day Full Day Full Day /Lunch |
| August 10 - 14, 2009 | Half Day Full Day Full Day /Lunch |
| Emergency Contact | |
| Name | |
| Phone | |
| Additional Comments | |
Day Camp - East Windsor PAL 30 Airport Rd East Windsor, NJ 08520 | |
| PARENT/GUARDIAN CONSENT AND WAIVER | |
| I hereby represent that the above information is true and accurate and the named applicant is in good health and has my permission to participate in the Zizo Soccer Programs. I acknowledge that soccer is a contact sport and that there is a risk of injury from participating in the camp and its related activities. I HEREBY WAIVE AND RELEASE Mohamed "Zizo" Sherif, Zizo Soccer Programs and its agents, servants and employees from any and all liability and claims for damages. In the event of an emergency I hereby give permission to such Medical personnel as necessary to render treatment. | |
| Parent/Guardian Signature (required) ________________________________________________________________ | |
Call for more details at: (609) 558 - 2745 and leave a detailed message Email: info@zizosoccer.com ________________________________________________________________ | |
| Print and send this form, along with payment to : | |
| |