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Premier
Soccer Camps
For boys and girls ages 5 to 14
Evelyn Greer Park - Pinecrest
8200 SW 124 Street, Miami, FL 33156
Tel: 305.926.9302 :: 305.606.9586
_____________________________________________
Name
__________
Date of Birth
____
Male
Female
Age
__________________________________________________________________________________________
E-Mail Address (Please Print)
Secondary E-Mail Address (Please Print)
_____________________________________________
___________________
Name of Parent/Guardian
Any known allergies:
Cell Phone 1
___________________
Cell Phone 2
_________________________________________________________________________
Please check all appropriate boxes
Session 1: June 8-12
Session 2: June 15-19
Half day camp from 9am to 12noon - $150
Full day camp from 9am to 4pm - $265
Session 3: June 22-26
Half day camp from 1pm to 4pm - $150
Half day camp includes 1 Soccer Ball, 1 Camp T-Shirt, Camp Certificate and Evaluation.
Full day camp includes Healthy Lunch (catered by ITALIAN SPORTS GRILL), 1 Soccer Ball, 1 Camp T-Shirt, Camp Certificate and Evaluation.
10-15% Discount if you sign up for multiple sessions: 1st Session attended full price – 2nd Session attended 10% discount – 3rd Session attended 15% discount
Sibling Discount: 1 st Camper full price – 1st sibling 10% discount– 2nd or more siblings 15% discount
T-Shirt Size:
YS
YM
YL
YXL
I understand that the amount paid is for the designated dates and covers instructions, insurance, a ball, a camp t -shirt, a certificate and
evaluation (lunch for FULL DAY CAMPERS ONLY). Full payment must accompany registration form. No deductions shall be applied for late a rrival
or early departure. I hereby certify that my son or daughter is in good health and may participate in all camp activities. In case of an emergency,
I grant permission for my child to be given emergency treatment by paramedics and at a local hospital. Any refund granted or any returned
check from the bank will result in a $25.00 administrative fee.
Waiver of Liability
In recognition of, and with the knowledge of, the fact that engaging in the sport of soccer could involve substantial risk of personal injury, I, The
undersigned, warrant that my child is in good physical condition and hereby agree to assume the risk of any injury he or she may suffer as a
result of his/her participation in Premier Soccer Camps/ Mega Sports LLC. Therefore, in consideration for being permitted to participate in such
camps, I hereby release, waive, and forever discharge Premier Soccer Camps/Mega Sports LLC, Village of Pinecrest from any and every claim,
demand or actions of whatever kind, arising from any bodily harm or personal injury resulting from any accident which may occur as a result of
participation in these camps. Further, and to the same extent and scope, I release said parties from any claim whatsoever which may be
attributable to the receipt of first aid or other emergency treatment rendered my child in connection with his or her participation in such camps.
I understand the Premier Soccer Camps/Mega Sports LLC will not provide any assistance with any medical bill(s) associated with the camp
should my child be injured.
___________________________________
Parent/Guardian
___________________________________
Signature
Checks MUST be payable to MEGASPORT LLC and mailed to:
Premier Soccer Camps
15481 SW 148 Terrace
Miami, FL 33196
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Date