Please print the application below, complete it, and mail it along with your payment to:
PO Box 661014, Arcadia, CA 91066
or reverve your spot Fax your completed form to
661-252-7789

Player Name (complete) Age Sex Parent or Guardian Name (complete) Street Address City Daytime Phone Evening Phone Email Emergency Contact Emergency Contact Phone Applying for (describe camp or session): Waiver of Liability - I hereby authorize the Director and/or staff member of the CLINT GREENWOOD ACADEMY to act for me according to their judgment in any emergency requiring medical attention. I also hereby waive and release Clint Greenwood Soccer Academy from any and all liability for any injuries incurred while at Clint Greenwood Soccer Academy. Signed:_______________________________                     Date:___________

Copyright 2005, Clint Greenwood Soccer Academy