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2015 This camp starts June 22, through June 26 Breakfast 8 – 9 Camp 9 – 2. At Walter E. Hall, 1226 W. Casino Road, Everett WA 98204 Ages: Minimum – 6 to 14 years old. No exceptions. 14 year old soccer players should consider acting as a coach. See space below. Registration begins now and ends June 14. Space is limited to the first 500 children. $20 fee includes soccer ball and a t-shirt. Child’s Name: of School: Address: Phone T-shirt/Uniform Size: (Circle One) Youth: L Adult: S M L XL Release and Hold Harmless Agreement: I, the undersigned, am the legal parent/guardian of the above-named child. I acknowledge and understand that the program in which my child is enrolling will involve a certain amount of strenuous physical activity and risk of injury. I agree to assume all risks associated with the program and further agree to release and hold harmless the City of Everett, its officers, agents, employees and volunteers from and against any and all liability, loss, claims, costs and expenses for both personal injury and/or property damage, including reasonable attorney fees which may arise as a result of my child’s participation in the program. If you believe it is necessary to obtain the service of a doctor or hospital to render service and/or treatment to my child, I hereby authorize you to do so at my expense. Photo Release and Hold Harmless: I hereby grant permission and authorize the City of Everett to use, publish, copyright, and re-publish my or my child’s photograph, in whole or in part, unchanged or modified, in all media that exists now or later, without further consideration, for purposes of promoting, describing and advertising events and programs sponsored or co-sponsored by the City of Everett. The undersigned agrees to release and hold harmless the City of Everett, its officers, agents, employees and volunteers from any and all claims, suits, actions, damages or compensation in any way related to the use and reproduction of photographs or film taken of me or my child. Signature of Parent/Guardian (REQUIRED) Date Please send a check or money order for $20.00 to: Casino Road Futbol Academy CASINO ROAD FÚTBOL ACADEMY 2015 ---PAGE BREAK--- PO Box 4305 Everett WA 98204