EmailMeForm
MLUSC Spring Break Camp 2024
PARENTS INFORMATION
Mothers Name
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Fathers Name
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Cell Phone Number #1
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Cell Phone Number #2
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Email #1
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Email #2
How Many Children are you Registering?
*
Please select
Only One Child
Two Children
Three Children
Does your Child Currently play with Miami Lakes United SC?
*
Please select
Yes - MLUSC Rec Player
Yes - MLUSC Academy Player
Yes - MLUSC - Travel Player
No - First Time Player
No - Play for another Soccer Club
What is your Team Coach name from this past season?
What is your current Club Name?
Please list the people that will collect your child at the end of the day.
*
(Name / Phone number / Relation to your child)
PLEASE NOTE: the above listed people will need to provide ID
CHILD #1 INFORMATION
#1: Child's Full Name
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#1: Date of Birth
*
CHILD #2 INFORMATION
#2: Child's Full Name
#2: Date of Birth
CHILD #3 INFORMATION
#3: Child's Full Name
#3: Date of Birth
Payments
What Days will your First Child be Participating in?
1st Child: All 5 Days of Spring Break Camp
1st Child: Monday Mar 25
1st Child: Tuesday Mar 26
1st Child: Wednesday Mar 27
1st Child: Thursday Mar 28
1st Child: Friday Mar 29
What Days will your Second Child be Participating in?
2nd Child: All 5 Days of Spring Break Camp
2nd Child: Monday Mar 25
2nd Child: Tuesday Mar 26
2nd Child: Wednesday Mar 27
2nd Child: Thursday Mar 28
2nd Child: Friday Mar 29
What Days will your Third Child be Participating in?
3rd Child: All 5 Days of Spring Break Camp
3rd Child: Monday Mar 25
3rd Child: Tuesday Mar 26
3rd Child: Wednesday Mar 27
3rd Child: Thursday Mar 28
3rd Child: Friday Mar 29
Do you need Extended Time/ Care for your Child?
Please select
Yes, I need Extended Hours - $60
No - Ill arrive at 10am and leave at 3pm ($0)
Do you need Extended Time/ Care for both your Children?
Please select
Yes , I need extended hours - $120
No - Ill arrive at 10am and leave at 3pm ($0)
Do you need Extended Time/ Care for all three (3) of your Children?
Please select
Yes, I need Extended Hours - $180
No - Ill arrive at 10am and leave at 3pm ($0)
INSURANCE
Does your Child need our Insurance
*
Please select
No - I have our own Insurance ($0)
Yes - I will need WestPoint Insurance as a Primary ($10)
$0 if you have your insurance as a Primary
$10 per week for our partnered ALM Insurance as a primary at PSN Park
Primary Insurance Details
(your childs insurance carrier and policy number)
Medical Concerns
Food Allergies
REFERRALS
How did you hear about this Camp?
Be sure to let Others know about the Camp
TERMS & CONDITIONS
I have read and agree to the Terms of Service
*
Yes, I agree.
If your child is covered by a private insurance, you must provide us with proof of your child’s insurance coverage. If your child is not We offer this through our Partners ALM Sports Insurers at a cost of $10.00 for up to 7 days during the Winter Break camp. I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course, other than imposed by law. I also allow MLUSC to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email info@miamilakesunitedsoccerclub.com. I confirm that my personal insurance is correct and bears responsibility in case of accidents. I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.
I agree and understand that all payments are non-refundable
*
Yes, I agree.
Total
$2.50
