Registration Information
Programs: Surrey Breakers Girls Soccer Camps
Season: Spring & Summer
Dates: May - August 2010
Open to: Girls
Age Group: U6 - U18 (check camp for age group)
Program: All levels
Contact: Don Tupper, Technical Director:
dtupper@surreybreakers.com.
NOTE: Please enter all required fields below. You will receive a confirmation email upon successful form completion. If not, please email Surrey Breakers at dtupper@surreybreakers.com.
"*" is a required field
1. Player Information:
*Firstname: *Lastname:
*Birthdate:
*Age Group:
*Played Last Season?
2. Main Contact Info:
*First Name:
*Last Name:
*Phone (main): ()
Cellular (main): ()
*E-mail:
*Street:
*City: *Prov:
*Postal Code:
*Medical Concerns?
3. Registration Info:
*Program:
*T-Shirt Size:
*Program Code:
Program Cost: $
BCSA Insurance: $
GST: $
Total Cost: $
* Waiver: I/We, the legal guardian(s) of the above named player, approve their participation in the SBGSC activities. We also agree that the Surrey Breakers Athletic Association (SBAA), Surrey Breakers Girls Soccer Camps (SBGSC), Fraser Valley Soccer4all, nor any sponsors, coaches, managers, assistants and others involved will not be held responsible for any accidents or loss, and agrees to release any and all claims, demands and suits that may arise all coaches/managers for all claims and damages which may arise as a result of/or by reason of such accident or loss.
Payment method: