ALCAN SOCCER DEVELOPMENT PROGRAM REGISTRATION
(To be eligible for Early Bird prizes registration must be postmarked, or received online, by April 30)
Mail to: ALCAN Sports: P.O. Box 80691, Fairbanks, AK, 99708 Phone 907-455-4203
Drop Off at Play It Again or Sport King

NAME: _________________________________________ AGE: ____________________

ADDRESS: _________________________________ CITY: ________________________

STATE: ________ZIP: _____________ EMAIL:  __________________________________

HOME PHONE: _____________________ DAYTIME PHONE: _______________________

HEIGHT: ___________  WEIGHT: ___________________

SPORTS: ROOKIES:Ages 8-9 ____ DEVELOPMENT: Ages 10-11  _____  PROSPECTS: Ages 12-13  ______ JUNIORS: Ages 14-18 ____

SPORT SELECTION : SOCCER DEVELOPMENT PROGRM

MEDICAL INFORMATION: (Allergies or any special conditions):__________________________
_____________________________________________________________________________
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ALCAN SPORTS CAMP: May 26 - July 24 - Full Day Program: _____  $2000 May 26 - July 24 - Half Day Program - AM _____  $1000  May 26 - July 24 - Half Day Program - PM   _____  $1000

FAMILY DISCOUNT:  Calculate Your Family Discount Second Child in Family 10% Discount                 Third, Fourth, Fifth Child in Family 15% Discount Enter Discount Here:

PLEASE TOTAL YOUR REGISTRATION TEAM ALCAN SUMMER CAMP TOTAL AMOUNT                        ____________ TEAM ALCAN SUMMER CAMP FAMILY DISCOUNT:                    ( __________ )                                      TEAM ALCAN SUMMER CAMP TOTAL PAYMENT DUE  ____________

PAYMENT OPTIONS: ENCLOSED IS A CHECK OR MONEY ORDER FOR THE FOLLOWING: ___ DEPOSIT ($500)         ____ TOTAL PAYMENT * Deposit is non-refundable

ALCAN SPORTS and ADVENTURE INSURANCE WAIVER
The applicant, his/her parents and/or guardians, acknowledge that the sports and/or the activities herein may include risks of physical contact and injury, and agree ALCAN SPORTS, its agents, servants, employees, instructors, and directors, shall be held harmless and not liable for any injury or damage to the participants as a result directly or indirectly caused by attending the school. The applicant, his/her parents and/or guardians also agree to indemnify the UNIVERSITY OF ALASKA FAIRBANKS, TANANA VALLEY FAIRGROUNDS ASSOCIATION, and the FAIRBANKS NORTH STAR BOROUGH, their employees, agents, and managers from all claims and damages.


NAME OF PLAYER: ________________________________ DATE: __________________

SIGNATURE OF PARENT OR GUARDIAN: ____________________________________