Program Requested

Program Requested Outfield Fall Pre-Season Camp Storm Fall Pre-Season Camp Goalkeeper/Striker Fall Pre-Season Goalkeeper Fall Pre-Season Camp Goalkeeper Fall Camp Goalkeeper Fall Conditioning Camp Elite Program Speed & Agility Program Goalkeeper Program Pre-Tryout Program Match Analysis Program Goalkeeper Match Analysis Information Update

Preferred location

Preferred location Fort Collins Denver South Denver C4 Fossil Ridge High School

This Registration Form will be submitted to the Core Soccer Academy

Parent/Guardian first name

Mr Mrs Miss Ms Dr

Parent/Guardian Surname

Address

Town/City

State

ZIP Code

E-mail Address

Home Telephone

Mobile

Work Telephone

Alternative Emergency Phone Number

Student first name

Student Surname

Date of Birth

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

- Year - 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Month January February March April May June July August September October November December

Important Medical Information

Other Relevant Information

I have read and agree to the Terms and Conditions

I have read the legal disclaimer opposite

Female Male

To prevent spamming from applications, please type the characters shown into the box below:

Legal disclaimer:

      

I give permission for the aforementioned student to participate in the program run by The Core Soccer Academy.

 

I confirm that I have read and accept the 'Terms & Conditions' as laid out by The Core Soccer Academy.  

 

I understand that whilst every effort is made to ensure the safety of all participants, all physical activity carries a certain amount of risk.

 

I understand that the student participates at his or her own risk. I accept that all kit and items brought to the program by students are done so at their own risk.

 

I understand that from time to time photographs and video footage may be taken for publicity purposes and I am happy for my child to be included in this publicity.         

 

Payment for the Program

      

Payment for the Core Soccer Program should be made in advance by PayPal using “sales@coresoccer.com”, by check or, at the latest, on attendance at the first class of the program. Checks to be made payable to “The Core Soccer Academy”.