Registration Form

Please use the form below to register for your selected program.

Soccer Camp/Academy Name:

Player Information

First Name:
Last Name:
Date of Birth:
   
Parent / Guardian's Address:
Apartment / Unit #:
City:
Province:
Postal Code:
   
Parent / Guardian's Phone Number:
Parent / Guardian's E-mail Address:
   
Number of Years Played Organized Soccer:
Club:
Position:
Does this Player have any medical conditions?

Disclaimer

My child is in general good health and has my permission to participate in soccer programs. I consent to the above named player participating in the activities of Primo Sports Soccer Academy, and I acknowledge that there are risks associated with such participation.

 I understand and accept the above disclaimer.
Name: Date: