ATLANTA GIRLS SOCCER CAMPS
2008 Application (Print and Mail)
Camper's Name:____________________________________ Age: (summer '08) ______
Team:________________________________________ Age Group: (fall '08) U- ______
School: ______________________ Grade: (fall '08)_____T-shirt size: YM YL AS AM AL
Parent(s)/Guardian(s): _____________________________________________________
Address: __________________________________________________
City: __________________________ State: ______ Zip:_____________
E-mail: ____________________________________________________
The Galloway School - Athletic Complex
2400 Defoors Ferry Rd. Atlanta, GA 30318
[circle Session(s)]
Session 1 * June 23-26 * $150 * Ages 13-16 * 5pm - 8pm
Session 2 * July 7-10 * $150 * Ages 15-19 * 5pm - 8pm
$15 Discounts: (select a maximum of two applicable discounts)
1. Employee Discount - parent works full-time at The Galloway School
Title/Position:___________________ ________________________
2. Alumni Camper - attended Sabo's 2007 or 2006 Camp
3. Sibling - sister (name)_________________________(applicable for each additional sister)
4. Team - (name) _______________________ 8 players minimum (mail applications together)
Special requests: ex. group my daughter with (names of friends), etc.____________________
________________________________________________________________________
Please mail Application, Consent Form and full payment payable to:
Atlanta Women's Soccer, Inc.
c/o Michael Sabatelle, 1013 Main Street, Stone Mountain, GA 30083
($50 non-refundable deposit/session)
($25 fee charged for all returned checks)
A confirmation and additional information will be sent via e-mail
Consent Form / Release of Liability
I, the undersigned (parent/guardian), hereby permit my child to participate in the Atlanta Girls Soccer Camps offered by Michael Sabatelle, and by execution of this release, I acknowledge and agree that all requirements, directions, supervision, and standards set by the directors and staff of this program shall be established for her benefit. I do hereby indicate that she is in good health, physically fit and mentally capable of participating in soccer and camp activities, is covered by accident and health insurance, and give full approval for her participation in the program. I, hereby acknowledge that participation in recreational and soccer camp activities involves inherent risks of physical injury and assume all such risks. I hereby voluntarily assume all risk of accident or injury to my child which may arise out of her participation in this program, and hereby release, relieve, discharge and hold harmless Michael Sabatelle, Atlanta Girls Soccer Camps, Atlanta Women's Soccer, Inc., camp/clinic employees, and host facilities, from any and all liability, whether for personal injury, property damages, or otherwise, arising out of or in connection with my daughters participation in this activity or any travel associated with this activity. In addition, I give my permission for the staff of the Camps/Clinics, to seek appropriate emergency medical attention for my daughter and for the emergency medical attention to be given to my daughter in the event of accident, injury, or illness. I will be responsible for any and all costs of medical attention and treatment. By signing below, I hereby acknowledge that I have carefully read and understood the above, before signing, and agree to comply with the above Consent Form / Release of Liability.
Parent(s)/Guardian(s) Sign: _____________________________________________________________
Parent(s)/Guardian(s) Print: _____________________________________________________________
Camper's Name: _____________________________ Date: ___________________
Insurance Carrier: ____________________________ Policy #__________________
Emergency Phone #'s: Home - ________________________Cell - __________________________
Work - ___________________________Others - _______________________________________
Additional Information: ___________________________________________________________________ |
