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Canada Brasil Futebol Academy
Registration form fall-summer 2018 Telephone: (819) 669-1612, E-mail: [email protected] Website: http://canadabrasilfutebol.com
Athlete name: _____________________________________________
Date of birth: Gender: ________
Parent name: Father __________________________________
Mother: _________________________________
Address: _______________________________________________________________________
Telephone: Cell: _______________________
Contact in case of emergency: E-mail: _______________________
Health insurance #: _________________ Allergies: ________________________
Category: Please choose a category.
Parent-child
SUNDAY 9am-10am
Par des vignobles
75$
Babyfut 1 (3-4 years)
THURSDAY 6pm - 7:30pm
Parc des vignobles
185$
Embaixadinha 1 (5-6 years)
MONDAY 6pm - 8pm
Parc Achbar
230$
Embaixaidinha 2 (5-6 years)
WEDNESDAY 6pm - 8pm
Par Jean-Gardy-Bienvenu
230$
Ginga 1 (7-8 years)
MONDAY 6pm - 8pm
Parc Achbar
230$
Ginga 2 (7-8 years)
TUESDAY 6pm - 8pm
Parc Jean-Gardy-Bienvenu
230$
Pedalada (9-11 years)
TUESDAY 6pm - 8pm
Parc Jean-Gardy-Bienvenu
230$
Teens-adults (12+)
WEDNESDAY 6pm - 8pm
Parc Jean-Gardy-Bienvenu
200$
Please chose a method of payment Multiple payments (for 2 registrations and more)
Cheque or cash
Interac e-Transfer Uniform
Online (credit or debit) xs s m l
Classes are between May 14th and August 9th, 2018 (12 classes) * *No classes between June 22 and July 1
*Parent-Child classes are between May 13th and June 17th (6 classes)
No reimbursements will be given after 1 class. The Academy reserves the rights to cancel a class and
reimburse the players if 10 registrations per class is not achieved before the beginning of the classes.
The registration form should be sent by email BEFORE March 31st and the full payment (or
postdated cheque) should be given BEFORE April 14th, 2018. Registration will be reserved upon
receipt of the registration form, but only be valid upon receipt of payment.
AUTHORIZATION: I authorize officials of the Academy Canda-Brasil Futebol to provide all necessary emergency care and, where appropriate, if we can not reach me, I promise to pay all costs of transportation by ambulance and medical expenses. The Academy cannot be held responsible
for any accident. I authorize the Academy Canda-Brasil Futebol to take pictures and videos that will be used for promotional purposes.
Electronic signature: ______________________________ Date: ______________________