2005 USF SOCCER CAMP APPLICATION


NAME:______________________________________________ PHONE ( )_______
ADDRESS:___________________________________________ CITY/ZIP:__________
AGE:________ DOB:___________ GRADE:______ SCHOOL:____________________
PLAYING EXPERIENCE:_________________________________________________
T-SHIRT SIZE: M L XL XXL
Please note any medical condition:____________________________________________
________________________________________________________________________
Insurance company:_______________________________________________________
Doctor’s name/phone number:_______________________________________________
Emergency contact:______________________________ Phone: ( )______________


I hereby authorize the staff of the USF Soccer Camp to act for me according their best judgement in any emergency requiring medical attention and hereby waive and release the USF Soccer Camp from any injuries or illness while at camp. The camp staff has my permission to seek any emergency treatment deemed necessary for my child while in attendance at the camp named above.


Parent/Guardian Signature:__________________________________________ Date:_____________


_____June 13-17 _____July 17-21 _____August 1-4

*A $50 deposit is required for all camps. The deposit must accompany this application and is non-refundable.

Balances are due one week prior to the start of camp.

Mail Check to: USF Soccer Camp
Men's Soccer Office/Josh McKay
University of San Francisco
2130 Fulton St.
San Francisco, CA 94117-1080

For more information call 415-422-2907