Player Registration

To register to any of our camps, please fill out the registration form, print it, sign it and send it to

World Ambassador Soccer Academy
P.O. Box 1815
San Mateo, CA. 94401

If you would like to recieve a hardcopy of the application, please request it by calling 650-595-8188 or sending an email to wasasoccer@aol.com.

All applications must be recieved with a deposit of $80, which will be subtracted from the total fee. Refunds must be requested one week prior to the start of camp ($50 is non-refundable). On the first day of camp, the balance of the fee must be paid in full. Registration information and directions will be provided and directions will be provided upon receipt of the application.

I will be attending as an individual a member of a team (send forms together). Pleae register me for the following camp(s):

June 18 - 22 (San Mateo)
July 21 - 25 (Chabot)
July 23 - 27 (Union City)
July 28 - August 4 (Chabot)
August 4 - 8 (Chabot)

Please check:

	Ages 5-10 9am - 12pm San Mateo: $160
	Ages 11-15 12:30pm - 3:30pm San Mateo: $160
	PEE WEE 9am - 12pm

Extended Hours: (add $40)

7:30 am to 9 am
3:00 pm to 5:30 pm

Make checks payable to WASA or register at Recreation Center of your choice.

Individual Name / Team:

First Name:
Last Name:
Address:
City:
State:
Zip:
Date of Birth:
Age:
Sex:
Playing Ability:
Years of playing experience:
T-Shirt Size:	Small Medium Large
Parent/Guardian Name:
Day Phone:
Work Phone:
Emergency Contact / Phone:

Waiver Exclusion Clause

Please read carefully and sign below

Recognizing the possibility of physical injury associated with soccer, I hereby release, discharge and absolve and agree to indemnify World Ambassador Soccer Academy, Tony Igwe and his employees and associated personnel, City of San Mateo, the San Mateo Union High School District, their employees and associated personnel, Union City, their employees, officers, program and activity instructors, Chabot College, City of Hayward and the School District of Hayward and their employees, and associated personnel of the school district from any and all liability for injuries and illness registrant may incur while participating in the camp. I hereby give my consent for camp personnel to authorize any and all medical and dental treatment for registrant and I accept full financial responsibility for said treatment. In addition, I agree to the following rules of fair play and conduct set by WASA. I understand that failure to do so may result in suspension in participation.

Parent/Guardian Signature:	_____________________________
Insurance Co. / Policy #:	_____________________________
Date:	_____________________________

Print, sign and mail this page to

World Ambassador Soccer Academy
P.O. Box 1815
San Mateo, CA. 94401