BRIT-WEST SOCCER CAMP APPLICATION FORM (Only For Camps)
| PLEASE RESERVE MY PLACE AT CAMP
Location_______________ dates__________
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| Campers Name:________________________________________________ | ||
| Last | First | |
| Age:____________________DOB:________________________________ | ||
| Address:_____________________________________________________ | ||
| Street | ||
| ____________________________________________________________ | ||
| City | State | Zip |
| Your Email:___________________________________________________ | ||
| Telephone:____________________________________________________ |
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| Home | Business | |
| Emergency Contact:_____________________________________________ | ||
| Name | Tel.# | |
| Insurance Carrier:_______________________Policy #:_________________ | ||
| COST OF CAMP(s): $__________ | ||
| $10 DISCOUNT 2ND CHILD: $__________ | ||
| $10 DISCOUNT ADDL. SESSION: $__________ | ||
| TOTAL AMOUNT ENCLOSED: $__________ | ||
*We prefer full payment with this application.
$25 is non-refundable. No refunds will be given for cancellations made less one week prior to camp.
**PAYMENT PLAN - You may divide the total amount into two equal payments.
One payment is due with this application & the other the 1st morning of camp.
***PLEASE INCLUDE AN EMAIL ADDRESS. CONFIRMATION WILL BE BY EMAIL ONLY.
I hereby indemnify and hold harmless Brit-West Soccer and its agents and employees from any and all claims arising our of injury to my child while participating in soccer camp activities. I authorize Brit-West Soccer to act for me according to their best judgement in any emergency requiring medical attention. In addition I understand that any photos or video of my child may be used by Brit-West Soccer for promotional purposes.
Signature________________________________Date:_________________
Make check payable to: BRIT-WEST SOCCER
MAIL COMPLETED APPLICATION & CHECK TO:
BRIT-WEST SOCCER
P.O. BOX 66-1718
LOS ANGELES, CA 90066
