Camper's name :
Age: DOB:
Address St.:
City: State: Zip Code:
Telephone #: Cell:
E-mail: Shirt Size:
Emergency Contact:
Insurance Carrier : Policy # :

Palos Verdes Los Angeles Torrance

-We prefer full payment with this application. $25 is non-refundable. We will not accept any refunds due to cancellation less than one week prior to camp.

PLEASE INCLUDE AN EMAIL ADDRESS. CONFIRMATION WILL BE BY E-MAIL ONLY.

I hereby indemnify and hold harmless California Soccer Camp and it’s coaches, employees, volunteers and sponsors from any and all claims arising from any congenital disease or injury to my child while participating in soccer camp activities. I understand that there are risks of injury to the named camper as a result of soccer camp activities, and knowingly and voluntarily assume all risks of such injury or congenital disease. I will be financially responsible for any medical attention needed during camp or resulting from an injury accrued at camp. In addition I understand that California Soccer Camp may use any photos or video of my child for promotional purposes. I also understand that each child has different learning soccer skill ability and therefore, it is up to the camper to give continuation to the skills and tactics learned at camp.

Please click on the "I Agree" button to send the information above.