Click here for a registration form in PDF format      

OR
 

Print the following form then  fill it in .
Mail this form and check, money order or credit card authorization to:

Office of Conference Services
Colorado State University
Fort Collins, CO 80523-8037
(970) 491-7501
(970) 491-7747 Fax
 
Name     Sex: Male   Female
Street Address: 
City:         State:        Zip:
Day Phone:    Home Phone:
Current age group playing in (Fall 2004) (as of 8/1/2004 - 7/31/2005)  Soccer Level U-     DoB:
Club/High School        T-Shirt size (adult sizes): S  M  L  XL
Roommate Request
(Every attempt will be made to match up roommate requests (only 2 participants per room), however, requests cannot be guaranteed. For Teams coaches will need to fill out roommate requests. Teams must send registrations in all together.)
Check here if you want to participate in the Goalkeeper Sessions.


 
Complete Steps 1-4 Registration Greeley, CO Totals
Step 1 Participants:
(What type of participant will
I be?)		 Individual Overnight Fee

$495.00

 

                        

 
Individual Day-Only Fee
(no lodging)

$445.00

 

                        

 
Coaches:
Coach Overnight Fee

$325.00

 

                         

 
Coach Day-Only Fee
(no lodging)

$280.00

 

                         

 
Step 2 Options:
(Do I want cookout
tickets?)		 Cookout Guest Tickets

   $ 10.00

                         
Step 3      
(When am I
registering?)		 If you are registering after July 2, then ADD:

   $ 15.00

                         
Step 4 Team Camp:    
Am I coming with my Team? Team Name                                                                                                

Total Amount Enclosed (U.S. Currency):

                         

Registration is being taken by Colorado State; the camp is being held at University of Northern Colorado

Method of Payment:
 (Full payment is required with registration)

Check or Money Order (Payable to Colorado State University)

 


                   Credit Card

           Visa   MasterCard

     Card # __________________________

     Expiration Date __/__/__

     Name as it appears on card:

       _______________________________

 

Mail or Fax to:
Office of Conference Services
Colorado State University
Fort Collins, CO 80523-8037
(970) 491-7501
(970) 491-7747 Fax

Refunds and Cancellations
A written cancellation request must be received by July 14 in order to receive a refund, less a $65 processing fee. No refunds will be given after the cancellation date. Substitutions will be accepted with advance notice. Total Soccer Academy reserves the right to cancel this program due to insufficient enrollment and limits its liability to registration refunds only.

Disclaimer
Total Soccer Academy or University of Northern Colorado are not responsible for any injury (or loss of property) or death to any person suffered while participating or in any way involved in the Total Soccer Academy, including negligence on the part of Total Soccer Academy or University of Northern Colorado, its trustees and officers.

Parent/Guardian Authorization
I verify that my child has been checked by a licensed physician prior to attending the Total Soccer Academy and is physically able to participate fully. I agree to allow my child to be treated by a licensed trainer and/or physician while attending the Academy, and assume all risks resulting from the participation in all activities of the Academy. I agree to hold harmless the Total Soccer Academy and University of Northern Colorado, it's trustees, and officers of any and all liabilities, actions, courses of action, claims and demands of every kind and nature whatsoever, which may arise in connection with or resulting from my child participating in any of the Academy activities.

If there are any medical, psychological or pharmacological conditions that would preclude this person from fully participating in all activities at the Total Soccer Academy, please specify inhibiting condition(s):                             

*Participant Signature/Date                                                           

*Parent/legal Guardian Signature/Date                                                           

*Parent/legal Guardian Name (please print)                                                          

*Medical Insurance Co. and Policy #                                            
*_____ We do not carry medical Insurance

Damage Policy
All lodging rooms will be inspected for damages prior to participants' arrival. On the last day of the camp, chaperones will inspect each room before participants check out. Any damages will be notes and participants will be responsible for the cost of any necessary repairs or replacements. The cost for damages will occur in common areas will be divided among participants on that floor. Participants found violating campus and/or housing rules and registration will be dismissed immediately from camp.

I acknowledge that I have read the section on room damage and agree to pay for any necessary repairs or replacement of supplies related to damages in my child's lodging area or any areas shared commonly by Academy participants. Parents, please initial: _______________

Total Soccer Academy has my permission to use any photo taken of me while at the Academy
for use in future advertising and/or promotion.

Reasonable accommodation is available for persons with disabilities. Three working day's notice is needed to prepare materials and services. (specify need.)

                                                                                                                      

*Please be certain to complete these items before mailing the registration form.