2017 Registration – Full Payment
06/01/2017

Camp Registration

$0.00

Child’s Name *

Year of Birth *

Address *

Current Team

Shirt Size *

Camp

Parent Information *

Parental Release *

This is to certify that my son/daughter has permission to participate in any and all camp activities. I assume all risks and hazards incidental to such participation and I do hereby agree to hold harmless the staff of the Valencia CF Academy NY from any and all claims arising out of any injury to my child. Furthermore, this verifies that the camper is up to date with his/her immunizations and is able to participate in all camp activities. In the event of injury my permission is granted for treatment as required at the nearest medical treatment facility. I also give permission for any images of my child to be used for promotional purposes

Payment Option *

If you wish to pay by card, click “Credit Card”, and payment will take place at checkout. If you wish to pay by cheque, click the checque option, and sent a cheque to the amount of $500.00 to Valencia CF Academy New York – PO Box 40139, Glen Oaks, Queens, NY, 11004