2005 Jose Caballero
Soccer Registration
Date(s) of session(s) _______________________________
Write in the session(s) to be enrolled for Summer Camp.
_____ @ $120.00/150.00 per session
Camp "A" at Golden Gate Park at the baseball diamond 7th and Lincoln $150 per session 9:00 am -12:00 pm
___Session 1 June 13-17
___Session 2 June 20-24
___Session 3 June 27 -July 1
___Session 4 July 4 - July 8
___Session 5 July 11 -15
___Session 6 July 18 - 22
___Session 7 July 25 - 29
___Session 8 August 1 - 5
___Session 9 Aug. 8-12
___Session 10 Aug. 15-19
___Session 11 Aug. 22-26
___Session 12 August 29- Sep. 2
Camp "B" at Rossi Playground $125 per session 4:00 pm - 6:00 pm:
___Session 1 June 13-17
___Session 2 June 20-24
___Session 3 June 27 -July 1
___Session 4 July 4 - July 8
___Session 5 July 11 -15
___Session 6 July 18 - 22
___Session 7 July 25 - 29
___Session 8 August 1 - 5
___Session 9 Aug. 8-12
___Session 10 Aug. 15-19
___Session 11 Aug. 22-26
___Session 12 August 29- Sep. 2
Name: _________________________________________________________Phone_____________________________
Address:____________________________City/Zip: ______________________________
Age: ______ DOB:________ Grade: ________ School: ___________________
Playing Experience:__________________________________________________
Please note any medical condition:___________________________________
Insurance Company:______________________Policy # ____________________
Doctor's Name and #:_________________________________________________
Emergency Contact:___________________________________________________
I hereby authorize the staff at Jose Caballero to act for me according to their best judgment in any emergency requiring medical attention and hereby waive and release the Jose Caballero from any injuries or illness while at camp. The camp staff has my permission to seek any emergency treatment necessary for my child while in attendance at the camp named above. I hereby release Jose Caballero from all liability which may arise as a result of my child's participation in the above activities.
Parent/Guardian Signature: ___________________________________________________Date:_________________
Print this form and make check payable to Jose Caballero, and send to:
Jose CaballeroYou can print this form, arrive at camp and participate, it is never too late!
Call 1.650.596.2888 for more information or send email
Emergency cell phone 415.999.7856
Have fun, go kids! Remember the spirit!