Academy Team Camp Registration

Academy Team Camp Registration Form: Please send in by July 21st.

Where:  George Pierce Park

When:    August 7th thru 11th 

Who:  All  U10's  and  U11's  5:30 P.M. to 8:30 P.M. at George Pierce Park

        All U12 Boys and Girls:  Week 2: August 7th  5:30PM  Scott Hudgens at River Green

Name of  Team_______________________________________

Name of Team Coach________________________________

Player's Name:

Last:___________________________________

First___________________________________

Parent's Name:________________________________________

Age Group:_______ Male_______Female_________

Contact Phone:________________________________________

Email:_______________________________________________

T-Shirt Size: Circle one:    YM    YL    AS    AM    AL   

Allergies/Health Concerns:____________________________________________

Parent Signature Required for Academy Team Camp Participation

I/we the undersigned hereby certify that I/we are the parent or legal guardian of the player. I hereby give my permission for the staff of the camp to seek appropriate medical attention to be given in the event of an accident or injury or illness. I will be responsible for any and all costs of the medical attention or treatment. I will not hold Jay Miller, AUSA or the Gwinnett Department of Parks and Recreation liable for any injury or accident occurring at the camp.

Parent Signature:________________________________________

Send to:      Jay Miller/AFUSA

                    4489 Silver Peak Parkway

                   Suwanee, GA  30024