AHS Soccer C
Camp 201
13 Registration Form Camper’s ______________
______ Name:_________________
Allatoona
High Scchool
Age: ____________ ____
_male ____female Alllatoona B
Buccaneer
p
Soccer Summ
mer Camp
201
13
Shirt Sizee: (circle one belo
ow) Youth SS M L / Adult SS M L Address::______________
______________
_____ city:___________________
______________
____ zip:___________________
____ parent’s _______________
_____
name_________________
parent’s email:_________________
______________
______ AH
HS SOCCER
ages 10
0 – 14
Allato
oona High Schooll
Parent phone #________
_______________
_____ For G
Girls
3300 Dallas Acworth High
hway
Acworth, GA 30101
77
70-975-6503
william.p
[email protected]
org
e
*S
Space limited to the
ffirst 25 reg
gistered
campers!
Coach
Bill Perry Coach Perry is in his 20th year of coaching and his 15th year in Cobb County. Coach Perry has been with the Bucs soccer program since its inception. His team has reached the state playoffs in the last 5 consecutive years, including a final four appearance in 2011 and the 2012 AAA championship title. AHS SOCCER PLAYERS The AHS Girls’ Soccer players from the 2011 and 2012 teams will be assisting with the camp coaching activities. CAMP INFORMATION
Cost of Camp: $125
Make checks payable to:
Allatoona Soccer Booster Club
Location: Camp will be conducted on the allweather sports turf field in the game stadium and
on practice fields. Campers should report to camp
for check-in at the entrance to the game stadium.
Complete the registration and
medical release forms with
check and mail to:
Allatoona High School
Attn: Bill Perry Girls’ Soccer Camp
3300 Dallas Acworth Highway
Acworth, GA 30101
Dates:
June 17th - 20th
Monday-Thursday
9:00-12:00pm
21st
(*Friday, June
will be used as a
rain-out date if necessary)
For Girls ages 10 – 14
Space limited to the first 25
registered campers!
Medical Release Form
I/We, the undersigned hereby certify that I(we) am (are) the parent or legal guardian of the camper. I hereby give permission for the staff of the camp to seek appropriate medical attention in the event of the accident, injury or illness. I will be responsible for all costs of medical attention and treatment. I/We the undersigned for ourselves, our heirs, executors and administrators waive, release and forever discharge the soccer camp, staff, officers, agents, employees, representatives and successors and assign of and from all rights and claims for damages, injuries or loss of personal property, which may be sustained or occur during participation in soccer camp activities or while at camp, whether or not damages, injury or loss due to negligence. I/We hereby acknowledge that our child is physically fit and mentally capable of participating in soccer camp activities. Insurance Co:____________________________ Policy Holder:_________________________ Policy #______________________________ Parent Signature________________________ Date________________________________ Special Considerations: Unless you notify us to the contrary we can only assume that each person registering for camp is in good physical condition and free of limiting conditions. Please notify us if there is any factor that might limit a person registering for camp so that we can do our best to provide the appropriate services and attention.