Laureano Ruiz Soccer Academy Corp. - 335 Sylvan Lake Road Hopewell Junction New York 12533
Phone: 845.226.GOAL (4625) Fax: 845.226.KICK (5425) play@lrsa.us
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Last Name
First Name
Address
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Parent/Guardian Name
Home Phone
Email
Mother Cell Phone
Father Cell Phone
T-Shirt size:
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Emergency Contacts:
Name
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I the parent/legal guardian of
Child Name
do hereby release, discharge and hold harmless Laureano Ruiz Soccer Academy Corp., its owners, directors, coaches and staff, waive any and all claims or liabilities for any losses, injuries to my child arising out of participation in any program at Laureano Ruiz Soccer Academy Corp. I authorize the staff of Laureano Ruiz Soccer Academy to act on my behalf in any medical emergency that may be necessary for my child. I also give Laureano Ruiz Soccer Academy permission to take photographs/video footage of my child participating in any program in which he/she is enrolled.
I understand that this footage may be used by Laureano Ruiz Soccer Academy for promotional and/or marketing purposes.
Parent/Guardian Electronic Signature
By typing in your name you agree to all terms and conditions.
Signature
Date
WEEKLY TUITION SCHEDULE: $ 650 / WEEK
$50 sibling discount per session
Name of the Sibling
If no siblings please enter "NONE" in the above field.
August 16th - August 20th August 23rd - August 27th August 30th - September 3rd
Check in is on Monday 7:00 – 8:45 AM of each week that your child is registered. Early registration is also available each Sunday from 3:00-5:00 PM for an additional $125 per child. If a player would like to stay any additional nights in between weekly sessions, there is an additional $150 fee per child per night.
Early Registration August 15 August 22 August 29
Additional Nights August 20 August 21 August 22 August 27 August 28 August 29
I agree to pay a $300 deposit per child per session with this registration form.
I understand that there will be no reduction of the camp fees for missed days for any reasons.
I understand that Laureano Ruiz Soccer Academy Corp. will make every effort possible to protect and safeguard the belongings of all campers. I will not hold Laureano Ruiz Soccer Academy Corp. responsible for my child’s equipment and belongings if damaged or lost, including theft.
Important camp information will be emailed after submission of application.
Please Note: for online enrollment a 3.3% admin fee will be applied.