Please use one form per family to get signed up.

1. One-Day Soccer Camp For all 1st thru 6thgrade boys and girls Saturday, July 26 from 8am-4pm Rolling Ridge Elementary School Field Cost: $15 Space is limited! Don’t delay! BRING A FRIEND! Featuring: Individual Skills Teaching - Character Building Messages - Ball Handling, - Shot Techniques, - Speed drills – Micro-team Scrimmages – and lots of fun!!! One-day soccer camp is sponsored by Christian Fellowship Church Local Outreach Department in partnership with Rolling Ridge Elementary School and the Upward Soccer League. www.cfellowshipc.org/local Questions? – Please contact Mike Trivett, Director of Local Outreach, Christian Fellowship Church at mtrivett@cfellowshipc.orgor 703-724-4907. www.cfellowshipc.org/local Participants must be entering 1st thru 6thgrade children (Fall 2014). Camp will go from 8am-4pm on Saturday, July 26 [breakfast will be served at 7:30am] Cost $15.00 per child (which includes, skill-building drills, breakfast, snack, and lunch.) (Financial Assistance is available upon request) Multiple same family member discount is available and goes as follows: 1stcamper: $15; 2nd camper: $10; 3rdcamper: $5; 4th camper: Free. Each participant will receive quality soccer skill-building, breakfast, snack, and lunch. Parents are invited to attend the closing ceremony at 3:15pm (time subject to change). Please use one form per family to get signed up. Send or bring your registration form along with payment by no later than Thursday, July 17th! Make checks payable to “CFC” and write in the memo “SOCCER CAMP” TO: Christian Fellowship Church - 21673 Beaumeade Circle Ashburn, VA 20147 (Attention: RR Soccer Camp or Mike Trivett) Name of Child: __________________________Age: ______ Grade Entering this Fall 2014: (Circle one) 1st2nd 3rd 4th5th 6th Shirt Size (Circle One): YS YM YL YXL AM AL AXLStreet Address: _________________________ City: _________________ Zip Code: _________ Gender: __ M __ FName of Parents/Guardian: ______________________________________ Email Address: _________________________Home Phone: _________________ Cell Phone: __________________ School enrolled in for the Fall 2014: ______________________________________ Allergies (including food) or other conditions which may limit activity: ____________________________________________ **Please note: If allergy is very severe your child will need to bring their own snacks and lunch. Any Medical Conditions of the child listed above: _____________________________________________________________ Any Medications the child is currently taking on a regular basis: __________________________ Camp Waiver: I understand that in signing this form, I release and hold harmless Rolling Ridge Elementary School and Christian Fellowship Church, its trustees, officers, employees, Camp Directors and staff, and any volunteers from any liability, past or future, fully and completely. I authorize your employees, volunteers, executive staff and/or designated medical professionals to administer emergency medical assistance. Parents/Guardian Signature: ______________ Date: _____________ Soccer • Please use this section for any additional children you are registering of the same family: • Child’s Name: _____________________ Age: _____ Gender: __ M __ F Shirt Size(Circle One): YS YM YL YXL AM AL AXL • Grade Entering this Fall 2014: (Circle one) 1st 2nd 3rd 4th 5th6th • Allergies (including food) or other conditions which may limit activity: ____________________________________________

2. Campamento de fútbol Para todos los niños y niñas del 1 al 6 grado Sábado, Julio 26 de 8am-4pm Rolling Ridge Elementary School Costo: $15 Espaciolimitado! No se demore! TRAIGA A UN AMIGO! presentando: - técnicas individuales- crear carácter-manejo de pelota – técnicas de tiro, - practica de velocidad – practicas en equipo – y mucha diversión!!! Campamento de fútbol es auspiciado por Christian FellowshipChurch Local Outreach Department con asociación con la Escuela de Rolling Ridge y la Upward Liga de Fútbol CFC. www.cfellowshipc.org/local Preguntas? – Por favor contactarse con Mike Trivett, Director de Local Outreach, Christian Fellowship Church al mtrivett@cfellowshipc.org or 703-724-4907. Participantes deben estar entrando al 1 a 6 grado (otoño 2014). Campamento será de 8am a 4pm el sábado, 26 de julio. [Serviremos desayuno a las 7:30am] Costo $15.00 por niño (incluye , practicas y técnicas, desayuno, merienda, y almuerzo.) (Asistencia económica esta disponible bajo petición) Hay descuento familiar (hermanos) y es la siguiente: 1er niño: $15; 2do niño: $10; 3erniño: $5; 4to niño: gratis. Cada participante recibirá técnicas de fútbol, desayuno, merienda y almuerzo. Los padres están invitados a asistir a la ceremonia de clausura a las 3:15 (hora sujeta a cambios). Utilice un formulario por familia para inscribirse. Enviar o traer su formulario de inscripción junto con el pago no más tarde del jueves, 17 de julio! Haga cheques a nombre de “CFC” e incluya en el memo “SOCCER CAMP” A: Christian FellowshipChurch- 21673 BeaumeadeCircle - Ashburn, VA 20147 (Attention: RR Soccer Camp o Mike Trivett) Nombre de niño: ______________________ Edad: _______ Grado en este Otoño 2014: (Marque uno) 1st 2nd 3rd 4th 5th6th Talla (Marque uno): YS YM YL YXL AM AL AXLDirección: ___________________________ Ciudad: ________________ Zip code: _______ Sexo: __ M __ FNombre Padre/Tutor: _______________________ Email _________________________ Telf Casa: _________________ Telf Celular: _________________ Escuela a atender en Otoño 2014: ________________ Alergias (incluya comida) u otras condiciones que limiten actividad: ______________________________________________ ** Nota: Si la alergia es muy severa su niño necesitará traer sus propios bocadillos y almuerzo. Cualquier condición médica del niño : ______________Todos los medicamentos que el niño está tomando actualmente de forma regular: _______________ Renuncia de campamento: Entiendo que al firmar este formulario, absuelvo de sostener culpable a Rolling Ridge Elementary y Christian FellowshipChurch, su Patronato, oficiales, empleados, directores de campamentos y personal y los voluntarios de cualquier responsabilidad, pasado o futuro, totalmente y completamente. Autorizo a sus empleados, voluntarios, personal ejecutivo y/o designado profesionales médicos de administrar asistencia médica en caso de emergencia. Firma de Padre o Tutor: ______________________ Fecha: _____________  futbol • Utilice esta sección para inscribir niños adicionales que se registran bajo la misma familia: • Nombre de niño: ____________________ Edad: _____ Grado en este Otoño 2014: (Marque uno) 1st 2nd 3rd 4th 5th 6th • Talla (Marque uno): YS YM YL YXL AM AL AXL • Alergias (incluya comida) u otras condiciones que limiten actividad:_______________________________________________