Leaside-East Toronto Soccer Club

PARTICIPANT NAME   
                                                                       


DATE OF BIRTH      
                                                                       


ADDRESS            
                                                                       


POSTAL CODE        
                                                                      


TELEPHONE          
                                                                      


OHIP NUMBER        
                                                                      


FOOD ALLERGIES     
                                                                      



OTHER THINGS TO WATCH FOR 
                                                                      

                          
                                                                      


I WANT TO COME:



WEEK JULY 19 TO 23, 2010     
                                                                      

WEEK JULY 26 TO JULY 30, 2010     
                                                                      


I certify the above information to be correct. I recognize that there is a potential
risk in participating in any sport. I absolve the officials of the LEASIDE-EAST TORONTO
SOCCER CLUB of any liability in respect to injury to my child while participating in the 
SOCCER SPORTS CAMP.



PARENT'S SIGNATURE    
                                                                        


DATE