Important Dates

"Ball2Feet" Camp Registration Form

(Circle One) Orono Camp / Brooklyn Park Camp / ISM Camp / Chisago Lakes

Players First Name:_________________________ Last _____________________________

Address:______________________________________________ Gender: M F

City: __________________________ Zip Code: _______________ Age:____________

Soccer Father:_______________ Hme # _________________ Wrk#___________________

Soccer Mother: ______________ Hme# _________________ Wrk# ___________________

Email Address: ________________________________________ _____________________

Emergency Contact & Ph#____________________________________________________

Please provide to F.S.A any Medical Conditions (Be Specific)

___________________________________________________________________________

Allergies: ___________________________________________________________________

____________________________________________________________________________

Parent / Gaurdian Agreement

I parent / Guardian of the registrant, I minor agree, that I and the registrant abide by the rules of Fergie's SoccerAcademy (F.S.A.) and it's affiliated sponsors. I hereby release, discharge and / or agree otherwise indemnify F.S.A., it's affiliated organizations and sponsors, it's sub contractors, coaches, managers, and volunteers, associated personnel including the owners of facilities utilized for the programs. Against any claim by, or on behalf of the registrant as a result of the registrants participation in the program. Also in the event of an Emergency the Director can call 911 for emergency medical help if needed.

Note: Please provide two signatures below

X Father Signature: _______________________________ Date: ____________________________

X Mother Signature: _______________________________ Date:_____________________________

Please Forward all Forms to:

FSA

PO Box 1140

Maple Grove, MN 55311

Note: Make Checks to FSA

If you have any questions on the "Ball2Feet" Soccer Camps please contact FSA.

You can print this form off and send it into the PO Box Address given here with a check for the Camp and FSA will send out an email to you to confirm they have recieved the Registration Form.

Thanks and see you at camp!!