Fan Zone - GOBLUEBIRDS

Bluebirds Camps

Soccer Player

Date of Birth

Parent's Name

Address

Street Address

City

Country

Phone

List any known medical conditions

*Campers will also recieve a camp shirt and two free tickets to an upcoming Club Atletico Saint Louis game*

PLEASE READ AND SIGN THE FOLLOWING WAIVER/MEDICAL RELEASE

I hereby give my permission for any and all medical attention necessary to be administered to my child in the event of an accident, injury, or illness. I authorize Club Atletico Saint Louis to request medical treatment as necessary to insure the well being of my child/ I also hereby waive and release Club Atletico Saint Louis, and staff for liability for injuries that may occur during training. I also understand that Club Atletico Saint Louis, retains the rights to use photos taken during the training sessions for public and/or advertising purposes.

Parent / Guardian Signature

Date

Email ricardo@gobluebirds.com for any questions you may have.

Payment

Discount

Subtotal

Tax

Total USD