21​st​ Annual Leland & Gray Soccer Camp

2017 Camp Dates: Boys and Girls Grades K – 6 ​July 17th - 21st H.S. Boys (7-12) July 17th - 21st

8:30 – 11:30 am 12:30 – 3:30 pm

Fees: The cost of the camp is $125, which includes the purchase of a soccer ball. Family discounts are: 2 for $220, 3 for $300, 4 for $380. Information: Learn skills through drills and fun games. Former campers and current varsity boys and girls players will be on hand to assist. High School camp will have technical coaching throughout the week from area coaches and college players. Please make checks out to ​Chris Barton​ and return to: Chris Barton, L&G Soccer Camp, PO Box 75, South Newfane, 05351

2017 Camp Registration Form Name _______________________________________ Address_____________________________________ _____________________________________________________

Age _______ 2017/2018 Grade Level _______ Parent/Guardian ____________________________ Home Phone ____________ Work Phone _________ E-Mail _____________________________________ Emergency Contact / Phone # __________________ ____________________________________________ Please check the camp you will be attending: _________ July 17 - 21 am __________ July 17 -21 pm Insurance waiver and medical release. Read before signing. I hereby authorize the staff of the above named camp to act for me according to their best judgement in any emergency requiring medical attention. I hereby discharge and covenant not to sue Leland and Gray Soccer Camp, Chris Barton, any of the servants, agents or employees from any and all liability or course of action whatsoever arising out of, relating to any loss, damage, or injury that may be sustained by my child, or to release, or otherwise, while participating in the camp program. My signature on this waiver also states that the above named camper is covered by my personal medical insurance policy. I am at least 18 years of age and fully competent, and I execute this release in full, adequate and complete consideration fully intended to be bound the same. Parent/Guardian Signature ________________________ Date ______ Insurance Carrier ________________________ Policy # __________