Eurostar Registration

Eurostar Soccer School

2010 Academy Registration

First and Last Name of Parent/Guardian *
Relationship to Student *
Address *
City *
State/Province/Region
Country *
Postal Code *
Phone Number * where can we best reach you while the student is away at the Academy
Email Address *

I hereby recognize and acknowledge that my child's participation in EuroStar Soccer Camp may involve bodily injury and/or emotional injury to myself and/or my child. In consideration of my child being permitted to participate in such event, I for myself, my child, my heir, my executors and administrators, hereby voluntarily and knowingly release, waive, and discharge EuroStar Soccer School, its officers and staff from any and all liability. In addition, I agree that my insurance company or I will pay for medical, hospitalization, damage or any other expenses resulting from my child's participation. I give consent for my child to be photographed and filmed while participating in camp activities and for the resulting material to be used by EuroStar Soccer School for promotional purposes.
As the Parent or Guardian of the Student do you agree with the above Disclosure *

Type the following: For security purposes, please type the letters in the image.