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Date: April 13, 2008
Time: 3:00 - 5:00pm
Location: Pizza Hut Park - Field TBD
9200 World Cup Way
Frisco, TX

3:00 - 3:15pm	Registration & Check In
3:15 - 4:45pm	Skills Clinic
4:45 - 5:00pm	Snacks & Giveaways

This free interactive camp allows kids with disabilities, either physical or developmental, ages 6-18 to experience first hand the sport of soccer. This fun-filled event will include instruction and skill development, use of equipment, games, prizes and concludes with a snack. Appearances could include FC Dallas players.

AbilityCAMP Registration Form
AbilityCAMP:
Participant First Name:
Participant Last Name:
Parent/Guardian Name:
Address:
City:
State:
Zip Code:
Phone:
Email Address:
Age:
Date of Birth:
Sex:	Male Female
Disabilities:
Seizures:	Yes No
Medications:
Wheelchair:	Manual Power
Emergency Contact:
Emergency Contact Phone:

AbilityCAMP Participant Waiver of Liability
In consideration of my child (participant) being permitted to participate in the FC Dallas AbilityCAMP offered by the National Sports Center for the Disabled, FC Dallas, FC Dallas Foundation, and Pizza Hut Park on behalf of my child, myself, and anyone who obtains rights from my child or me, I hereby voluntarily waive, fully release and discharge any of the above mentioned agencies and entities, their directors, officers, employees, agents, insurers, various sponsors and paid and non-paid volunteers from liability for injury, illness, death, damage or loss to participant or participant's property arising out of or in any way related to Participant's activities at the FC Dallas AbilityCAMP. I understand that the staff/volunteers of this camp are not allowed to administer medication or provide personal care such as feeding, toileting, and/or dressing. Anyone needing this type of assistance must make their own arrangements. I have read this form and understand its content and request registration for my child.
Agree:	Yes No
Photo Release

I grant permission for Participant's picture to be used in publicity or brochures related to this event.
Agree:	Yes No
Participant Name:
Parent/Guardian Signature:
Date:
Sign here:	__________________________
Please print this page out and bring it to the camp with you.

P.O. Box 1290, Winter Park, Colorado 80482 USA phone: 970.726.1540 or 303.316.1540 Fax 970.726.4112
Denver Office: 633 17th Street, #24, Denver, CO 80202 phone: 303.293.5711 Fax 303.293.5448 Email: info@nscd.org

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