[-**mtimn: Ths"ee h{{$*s S*cc*n

Smt*s: S- t# Jux*y$ S-RS Au"rgrlwt

T*rwes: Fffi S.3$am- 4.3$prx:h{m {#"##arm- {*.*ffi*tr}#n

falb#a

@, --: -

###swWw #w**wr f*s: ffi"S{swrflssw #wwr;ws #www#w#wpwra#: W&rprw ff mf# fe!#{E{#w

&$fuss"*m Smmm#r #ffiffips$exsxsmxwr #S$S

Bringing Communities TogetherWelcome to the Alberta Soccer Camp Program !

All ASA Soccer Camps are promoted in partnership with yourcommunity soccer program and proceeds will be used to supportyour soccer p-oqram's development.

CAMP INFORMATIONFUL[ DAY: 9:30am-4:30pmPlayers aged 8-14 years {lncludes t-shirt and baff)

HALF DAY: 10:00am-12:00pmPlayers aged 4-8 years (lncludes t-shirt only)

. ASA Soccer Camp curriculum focused upon individualtechnique development, fun games and practice scrimmages.

. Great Prizes and an emphasis on Fun!

. Goal: Everyone goes home with a passion and desire to play

soccer!

CAMP STAFF. ASA qualified coaches with specific camp training. First Aid trained and have CPIC police clearance. Camp ratios will not exceed a 15:1 ratio

CAMPER NEEDS. Suitable sports/soccer uniform including shin guards. Packed lunch for full day camps.. Adequate refreshments, sun-screen and/or rain-proof

clothing.

BOOKING A CAMPTo register for your local camp, please return this form andpayment either to your local camp representative or directly toASA {see below). There will be a 25% administration fee applied toany cancellations.

effieffi***ww ffiffiffiWffi

ra

I

I

PLEASE PRINT CLEARLY

Child's Name:

ParentlGuardian:

Address:

City Postal Code

Home Phone #:

Emergency Phone #:

Address:

Email

Birthdate: /d vl Gender:M/F

Shirt Size (each

Camp Location

player receives one): YXL / Adult S

Camp Dates Full / Half Day Camp

Alberta Health #:

CurrentClubl Team :

I, behalf my

child , his/her heirs, executors,

administrators and assigns, do hereby release the ALBERTA SOCCER

ASSOCIATION, and their heirs, executors and assigns from any and all liability

for any injury or damage suffered by *y child during or arising out of hisiher

parlicipation in the soccer school progrum. ASA uses photography and video

images for educational and promotional purposes. These maybe stored at ASA or

used at various locations. I hereby authorize ASA to reproduce images for any

purpose related to their business and promotion of future progpms.

Signature of parent/guardian

Pavment Info:

Camp Option: A

Amount: $--( )Cash ( )Cheque#

Visa/MC

C D

( ) Credit Card

Exp. /

* Please note: Applications without payment will not be accepted

MEDICAL CONSIDERATIONS :

Please list any medications your child has been prescribed:

Please use the space provided to inform us of any medical

considerations that may aid us to support your child at this camp:

Injuries

Allergies

Medical conditionPlease discuss any concerns with the camp director prior to arrival.

\*-. a:ris.*,:6:er -s.ilh.f

rEYllflll tvr I iIaI il I IaI N li

;

-ilfl ElrlaMltI|Il

*/