CLINIC REGISTRATION FORM

INDOOR AND OUTDOOR YOUTH CAMP REGISTRATION FORM

FVSA LINDENHURST BUBBLE

831 N QUEENS AVENUE. LINDENHURST, NY 11757

631.624.3883 631.624.3233

FVSA CLINIC REGISTRATION FORM

Clinic Date __________________________________

Clinic Name__________________________________

Indoor____ Outdoor ____

Player’s Name________________________________

Boy ____

Girl _____

Age ______

LIJSL Team __________________________________

LIJSL Division ________________________________

$ Amount Inclosed _______

Check (#) ______________ Cash ____________

Credit Card #________________________________ Exp Date _______________

Parent or Guardians Name (s) ___________________________________________

Address ____________________________________________________________

City_______________________________ Zip_________________

Home Number _____________________ Cell Number ________________________

Emergency Contact ____________________________________________________

Emergency Contact Phone Number ________________________________________

Email ________________________________________________________________

Important notes and checklist for Clinics:

*Please arrive 30 minutes prior to first day of clinic for registration

*Please arrive promptly at end of clinic day to pick up child

*Waiver form must be filled out for each participant

*Participant must bring a ball and shinguards everyday

*Refreshments are sold at the Bubble concession stand, but water and snack maybe brought each day