2009 CESA U10 - U14 Residential Team Camp At Furman University

1. 2009 CESA U10 - U14 Residential Team Camp At Furman University Under 10 - Under 14 Boys & Girls: July 16 - 19, 2009 4 Day Residential Player: $250 4 Day Commuting Player: $195 $15 Sibling Discount for additional members of same family The CESA Residential Team Camp for U10-U14 players will be held at Furman University. A full schedule will be given to each player closer to the date camp begins. For residential players, fee includes meals, rooming and daily training sessions. All players will receive a camp T-shirt. U10 - U14 Residential Team Camp: Thursday, July 16th - Sunday, July 19th, 2009 Player’s Name: _____________________________ Team: _______________________________ Address: ________________________________ City: _____________________ Zip: __________ Parents’ Names: __________________________________________________________________ Parents’ Phone: (H) __________________ (W) __________________ (C) ___________________ Email Address: ___________________________________________________________________ Emergency Contact: __________________________ Phone Numbers: ______________________ Roommate Preference (Players must be on the same team): ______________________________ In order to guarantee a roommate, both players must request each other before June 30th. T-Shirt Size: (Please circle one):YL AS AM AL AXL List Any Allergies / Medical Conditions: ________________________________________________ RELEASE AGREEMENT: In consideration of the application, I the undersigned, being the parent or legal guardian, intending to be legally bound hereby, for my heirs, executors, and administrators, waive and release any and all rights and claims for damage I may have against Carolina Elite Soccer Academy, the Camp Staff, the Medical Staff provided by Bon Secours St. Francis Health System and Furman University for any and all injuries suffered by my child at the above said camp. I attest and verify that my child is medically cleared to attend the above said camp. *Signature: ________________________________________________ *Date: ______________________ Registration Deadline: June 30, 2009 Please Return Entire Form & Make Check Payable to: CESA Attn: U10-14 Furman Team Camp Carolina Elite Soccer Academy 18 Boland Court Greenville, SC 29615 www.carolinaelitesc.com Form Revised 3-10-2009