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PROS Brazil—USA Winter Camp Registration

(Held at Tempe Sports Complex #3)

Winter Camp
Come have Fun !
At: Tempe Sports Complex
Active training !
Small sided Games!
Sign Up Early!
Outdoor Futsal!

Location: Tempe Sports Complex #3 PROS SOCCER CLUB

(just north of Warner on the east side of Hardy)
Dates: December 20th, 21st, 22nd 2010

U9(02) - U14(97) = 9:00am to 11am $50

U7(04) – U8 (03) = 9:30am to 11am $40
4 & 5 year olds = 10:00am to 11am $30

PIZZA PARTY on last day!

Add $5 to all signups after December 13th!

Player Name: __________________________ Phone Number: ________________

Address:______________________ City: ____________State: ______ Zip: ______

Birthdate: ________________ Current Club: ___________ Team: ______________

AYSA MEMBER: ________YES ________NO (Non AYSA members add $6.50)
Consent for Medical Treatment: As the parent or legal guardian of the player named herein, I hereby give consent
for emergency medical treatment as prescribed by a duly licensed doctor of medicine or dentistry. This care may
be given under whatever conditions deem necessary to preserve the life, limb or well-being of my dependent.
Signature of:
Parent/Guardian: ____________________________________________________________________

Address: ______________________________ City: ________________ State: ______ Zip: _______

Home Phone: _____________________Work Phone: _________________Cell: ________________

Emergency Phone: __________________________________________________________________

Email Address: _____________________________________________________________________

Medical Comments:
REGISTER ON OUR WEBSITE AT: www.prossoccer.org
Method of Payment: Check made out to “Pros Soccer Club”
Mail Check and this signed registration form to:
Pros Soccer Club 5235 S. Kyrene Ste. #109 Tempe, AZ 85283
Questions? Contact: Luciano Reis (480) 458-7738 lucianoreis@msn.com
Jesse Larimer (480) 236-6502 jesselarimer@msn.com
Marcos Martins (480) 213-8706 coachmarcos@hotmail.com
Vini Dos Santos (480) 703-9296 vinicasoccer@gmail.com