Wachusett Team Clinic

WACHUSETT TEAM CLINIC

Eligible Players: Returning JV/Varsity & Juniors | Seniors trying out.

Team Training Clinic

Krashes Field, Princeton MA

Time: 5:30-7:00 pm

Cost: $47.95/Player

Eligible Players*

PLAYER REGISTRATION

Student Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Date of Birth*

MonthDayYear

E-mail*

Primary Position

Secondary Position (s)

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

T-Shirt Size*

Gender*

MaleFemale

PARENTS/GUARDIAN INFORMATION

Parents Full Name*

First NameLast Name

E-mail*

Cell*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Insurance Carrier*

EMERGENCY CONTACT INFORMATION

Full Name*

First NameLast Name

Cell Phone*

Area CodePhone Number

E-mail

Disclosure

"Participants should be aware of safety concerns and should take normal precautions

when on any college campus: remain in your camp activities; always stay with other

members of your camp; park in well lit areas; never walk alone across campus at night; after dark, wait

for transportation inside a College building; report any suspicious person(s) or activities immediately to

Campus Police; and loitering in or around campus buildings and/or residence halls is highly discouraged.

No unauthorized guests are allowed on campus during any camp activity. Authorization can only be

granted by the Camp Director or Camp Operator."Board of Health Requirements" 430.190: General Program Requirements "This camp must comply with regulations of the Massachusetts

Department of Public Health and be licensed by the local board of health."

Zalgiris Soccer shall inform parents that they have the right to request copies of

background checks, health care and discipline policies as well as procedures for filing grievances.

Clinic Waiver Agreement

Camp / Clinic Waiver We/I hereby request you accept camper’s application for enrollment in the Zalgiris Camp/Clinic. In consideration of your acceptance of this application, we/I hereby agree to release, indemnify and hold harmless (Zalgiris Soccer), its agents, employees, representatives or assigns, including camp directors, the coaching and training staff and camp employees, from all claims resulting from any injury sustained by my child while traveling and participating in the camp. We/I further hereby give permission to the coaches, training staff or other medical professionals to provide medical care as deemed necessary to my child in case of injury or illness

I have read the release/waiver and *

Agree with its terms/conditions.Decline its terms / conditions.

Signature

ONLINE PAYMENT ONLY

Wachusett Team Training

Fee$75.00