Registration Info *REQUIRED*

Player's Name

Parent(s) Name

Address

City

Zip

Email

Home Phone

Mobile Phone

Date of Birth

Age

Current Team

Level

Please select one Division 1 Division 3 Recreational

T-Shirt Size

Please select one Youth Medium Youth Large Youth Extra Large Adult Small Adult Medium

Camp Session

*All camps will be held in the Cupertino Area, please check our
website for exact location of each camp

Medical Info *REQUIRED*

Insurance Provider

Policy #

Allergies

Medications

Secondary Contact Name

Phone Number

Waiver of Liability *REQUIRED*

I understand that soccer is a physical and strenuous sport. I acknowledge that there are always risks involved when participating in soccer and that injury can occur. As a parent/guardian of this participant, I waive all claims of liability against “Copa soccer Academy,” its coaches and staff, the city of the event, or the soccer park/field. I hereby give permission for my child to receive emergency medical care. This care may be given under whatever conditions are necessary to preserve life and the well being of my child.

Signature
(Type your name)

Pictures on www.CopaAcademy.com

Copa Soccer Academy often features pictures of athletes who attend our camps on our website and in promotional material.

Picture Release

I hereby give “Copa Soccer Academy” the absolute and irrevocable right and permission, with respect to picture(s) that have been taken of my daughter, while at the Copa Soccer Academy and may be used in the following:

To use, re-use, publish and republish the same in whole or in part, individually or in conjunction with promotional material and official website

I hereby release and discharge “Copa Soccer Academy” from any and all claims and demands arising out of or in connection with the use of the photographs, including any and all claims for libel.

I am the legal parent/guardian of the above-mentioned player and fully understand the contents thereof.

Signature
(Type your name)