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Individual Player Registration
Full Day Option Saint Anselm Overnight Soccer/Futsal Camp July 14-18
1
Complete Form
2
Payment
3
Confirmation
Option:
--Select--
Full Day (9:15 am -7:45 pm)
Price:
$539.00
Description:
Full day, for 2014 and younger
= Required Field
--Select Player--
GENDER
Please select...
Male
Female
CITY
STATE
--Select--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AB
BC
MB
NB
NF
NT
NS
NU
ON
PE
QC
SK
YT
DATE OF BIRTH
-SELECT MONTH-
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
-SELECT DAY-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-SELECT YEAR-
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Age Group by DOB:
Select Month/Day/Year
Home Phone
Cell Phone
SHIRT SIZE
--Select--
YM
YL
AS
AM
AL
AXL
CURRENT TEAM
CURRENT COACH
Grade
('24-'25)
:
--select--
1
2
3
4
5
6
7
8
9
10
11
12
Preferred Roommate:
Emergency Contact
Emergency #
Comments
How did you hear about us?
Previous Customer
Marketing Email
Website
Social Media
Brochure
School Flyer
Friend
Other
Approvals
I, the parent/guardian of the above named Registrant, in consideration of accepting the Registrant for their soccer and/or futsal programs and activities (collectively the “Programs”) and recognizing the risk of potentially significant physical injury occurring by participation in the Programs, including permanent disability or death, for myself and Registrant, do knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for the Registrants participation in the Programs. Further, I, for myself and Registrant, and on behalf of our respective heirs, assigns, personal representatives and next of kin, do hereby release, indemnify and hold harmless Brazilian Art Soccer Training, FutsalNH, its affiliated organizations and sponsors, and each of their employees, volunteers, agents, other participants, hosts, sponsors, advertisers, and the owners of the premises upon which the Programs are held (collectively, the "Releases"), with respect to any and all injury, disability, death, or loss or damage to person or property incident to Registrants participation in the Programs, and/or being transported to or from the same, which transportation I hereby authorize, and whether arising from the negligence of the Releases or otherwise, to the fullest extent permitted by law. I hereby warrant and represent that the Registrant has received a physical examination by a physician and has been found physically capable of participating in the Programs with no reservations or restrictions. I, for myself and Registrant, do hereby consent to have a doctor of medicine or dentistry, a licensed nurse or emergency technician provide Registrant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY
I, the parent/guardian of the above named Registrant, in consideration for accepting the Registrant for their Soccer and/or Futsal programs and activities (collectively the “Programs”) hereby grants to Brazilian Art Soccer Training and FutsalNH the right and permission, free from approval, review or cost, to photograph, record or otherwise capture the Registrants likeness in participating in the Programs for use in media, now or hereafter known, including, but not limited to pictures and video, to copyright the same in its own name, and which may be included in whole or in part for commercial or promotional use
CONTACT INFORMATION
GUARDIAN #1
Same as player
STATE
--Select--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AB
BC
MB
NB
NF
NT
NS
NU
ON
PE
QC
SK
YT
ZIPCODE
1 of the 3 phone numbers below must be filled in
HOME
WORK
CELL
PREFERENCE
Home
Work
Cell
I would like to volunteer
Coach
Assist. Coach
Field Marshall
Referee
Team Manager
GUARDIAN #2 (optional)
Same as player
STATE
--Select--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AB
BC
MB
NB
NF
NT
NS
NU
ON
PE
QC
SK
YT
ZIPCODE
1 of the 3 phone numbers below must be filled in
HOME
WORK
CELL
PREFERENCE
Home
Work
Cell
I would like to volunteer
Coach
Assist. Coach
Field Marshall
Referee
Team Manager
Add Another Player
CONTINUE
Refund Policy
Refunds will be given if requested 2 weeks prior to the start of the camp. Request for refunds within 2 weeks of the camp will result in a $150 administrative fee and requests for refunds within the final week will not be refunded.
Contact Info
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