To provide your child with prompt medical care, we must I certify that_____________________________has my
have a completed consent form on file. permission to participate in the HUSA UNITED SOCCER ACADEMY. I
further certify that the above player has medical insurance in case
_________________________________________________ of injury or emergency. I hereby grant permission to officials of
Camper’s Name Birthday (M/D/Y) the HUSA ACADEMY to act for me according to their best judgment
in any emergency requiring medical attention. Furthermore, I
_________________________________________________ hereby waive and release HUSA UNITED SOCCER ACADEMY, its
Health Card Number employees, agents, officers and staff for any accident or injury
sustained while at camp.
Known Allergies / Medical Conditions ACADEMY FEES
The fee for the duration of the academy is $175.00 for each
Medication Presently Taking
_________________________________________________ Complete the application and parental consent forms, and
Date of Last Tetanus Booster mail them with a check made payable to HUSA CONSULTING INC.
No telephone reservations will be accepted. All payments are due
no later than ________.
Does your child suffer from asthma?___________________
REFUNDS AND CANCELLATION POLICY
Does your child wear contact lenses?___________________ All campers who cancel, regardless of reason, will be re-
funded all pre-paid fees, except a $50.00 handling fee,
provided they cancel 10 days prior to camp. Any cancella-
List any recent injuries in the last 6 month: tions within 7 days of camp will be assessed a $100.00
handling fee. No refund will be issued for cancellations
_________________________________________________ made within 24 hours of the start of camp for any reason.
List any medication the child takes on a regular basis: CHECK IN/CHECK OUT
Campers will register between 12:00pm and 1:00pm. An all
_________________________________________________ camp meeting will be held at 2:30pm on the first day of
camp. The final session will be completed by 11:00am on
the last day of camp. Check out and a final all camp awards
EMERGENCY NUMBERS ceremony will be held at 12:00pm on the final day of camp.
Father’s Name Cell Number A certified trainer will be on site to offer prompt attention
to minor injuries and ailments.
Mother’s Name Cell Number SUPERVISION
All campers will be supervised by camp staff while participating in
_________________________________________________ HUSA United Soccer Academy.
Name and phone number to call if parents cannot be