GOAL KEEPER SPRING BREAK CAMP CLINICA DE FUTBOL PARA PORTERO Spring break 2015 @ Orchard Middle School Field, Wenatchee @ Orchard En La Escuela ______________________________________________________________________________ ______________________________________________________________________________ ó *Cleats & shin guards & are required! *Goalie gloves recommended *Don’t forget a water bottle * Se requiere zapatos de futbol y espinilleras *Traer bottella De aqua *Guantos de portero Question? Contact clinic coordinator Cindy Abouammo [email protected] or call 509-881-7089 Pareguntas? Comuniquese con Cindy O llame Al 509-881-7089 UNITING PASSION, UNITING COMMUNITIES, UNITING COMPETITION SPRING SOCCER CAMP REGISTRATION FORM REGISTARD PARA CLINICA DE FUTBOL Participant name / Participante:____________________________Age / Edad:________ DOB / Fecha De Naeimiento___________________Grade / Grado_______________________ Parent phone number/Telefono:HOME/CASA___________CELL/CELIVAR_____________ Address/Domicelio:______________________________________________________ City/Ciudad__________________________________________________________ Shirts size/Talla De Camisa: __________________ Emergency contacts/Contacto De Emergencia: Name / Nombre:____________________Phone / Tel:___________________________ Name / Nombre:____________________Phone / Tel:___________________________ Medical Insurance Co/ Seguro: _____________________________________________ Policy #________________________________________________________________ My daughter/son is in good physical condition and is cleared to participate in this activity / Mi hijo/hija esta en condicion fisica para uugar y puede participar en esta actividad. I give permission for my daughter to participate in this activity. / Doy permiso Que mi hijo/hija participle en esta actividad. I authorize the staff of this Wenatchee Valley United SC activity to obtain medical care if necessary and acknowledge that I am responsible for any and all medical expenses due to an injury or illness that occurs while at camp. / Doy permiso al personal de WVUSC que obtenga atencion medica si es necesario y reconozco que yo soy responsible de cualquier gasto, si ocurre una lesion durante esta avtividad. Parent Name / Nombra papa - Mama: _________________________________ Date:____________ Paren tSignature / Firma:_________________________________________ By checking this box, I am asking for financial assistance with this soccer clinic because of financial need. / Al checar, estoy solicitando ayuda financiera para esta clinica. UNITING PASSION, UNITING COMMUNITIES, UNITING COMPETITION UNITING PASSION, UNITING COMMUNITIES, UNITING COMPETITION