AFC AJAX Camp Registration London

In partnership with Chelsea Rovers FC

BOOKINGS CLOSED FOR 2023

Athlete Information

First Name

Last Name

Birthday

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Parent/Guardian Information

First Name

Last Name

Home Phone

Mobile Number

Emergency Information

Emergency Contacts First Name

Emergency Contacts Last Name

Emergency Contacts Phone Number

Emergency Contacts Alt Phone Number

Does the athlete have any allergies, chronic illness, or medical condition? If yes, please describe.

Is the athlete prescribed an inhaler? if yes, please explain any instructions

Other Information

What Football Club do you train with?

Why do you love football?

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Leisure Force Education and AFC Ajax during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Leisure Force Education and AFC Ajax, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of travelling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Leisure Force Education. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Leisure Force Education and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Permission to Photograph for social media & marketing - please email leisureforce.edu@outlook.com if you don't wish for your child to be in any promotional materials during and after the camp.

Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. the electronic signature will be equally as binding as an original manual paper signature. Any refunds will be minus the booking fee of 3% - 6 weeks or more before the camp, 6 weeks or less 50% will be refunded.

I agree to the terms & conditions

Thanks for submitting! Your offical AFC AJAX CAMP booking is confirmed.