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CHESHIRE

* Marks are mandatory

Name of Parent*
Name of Child(ren)* Male   Female
  Male   Female
  Male   Female
Address line 1 *
Address line 2
Home Phone* Work Phone
Cell* Email*
Emergency Contact* Phone
Dates of Camp
Location of Camp
Cost of Camp

Waiver:

I certify that my child(ren) is/are in excellent health and is/are able to participate in physical activity reasonably demanded by sports. I accept that it is possible my children will be training with older or younger players and understand when scrimmaging, players will be no more than two years older. I agree to hold Cheshire Soccer, its agents, its coaches, and Simon Moores harmless from any and all claims for injuries sustained during my child(ren)’s participation in aforesaid training. By signing below, I allow Cheshire Soccer to use photos or film taken during training as future promotional material. In addition, I hereby grant permission for my child(ren) to receive emergency medical treatment if such treatment is deemed necessary.

 

Parent Signature*

 
Note: Please either print out this page and sign the signature box and send with your payment,
or you may scan your signed form and email it to rob@cheshiresoccer.com.
Payments should be sent to: Cheshire Soccer, 154 Whisper Way East , Ledgewood, NJ 07852
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Cheshire Soccer - Commitment to Coaching & Enjoyment - Cheshire Soccer • 154 Whisper Way East • Ledgewood, NJ. 07852 Copyright © 2007 - 908 393 4131
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