WISS HOME PAGE
* please print this page and enclose it along with your payment.
Make checks payable  to: The WISS 53 Montee Ste Marie, Ste Anne de Bellevue, QC H9X 2B7
Name____________________________________________________________ Age ____ Sex: M __ F ___ T-Shirt Size (please circle) Youth Medium Large Adult Small Medium Large X-Large Address __________________________________________________________ __________________________________________________________________ __________________________________________________________________ Postal Code__________________ Parent's Name_____________________________________________________ Telephone#(Home)______________ Work _______________________ Cell ________________________ Email_______________________ Emergency  Info Contact ______________________________ Telephone ___________________________ Allergies?___________________________ Medicaire #__________________________ * All camps are from Monday to Friday 9 am. to 3 pm I Would Like to Register for the following week(s) (please mark an X in the right column and circle the location)
1. June 24^th-27^th	Beacon Hill/ ST-Lazare
2. June 30^th-July 4^th	Beacon Hill/Dorval
3. July 7^th-11th	St-Lazare/ Lachute
4. July 14^th-18th	Beacon Hill/Vaudreuil
5. July 21^st-25th	St-Lazare
6. August 4^th-8th	Beacon Hill
7. August 11^th-15th	ST-Lazare
I_______________________, attest and verify that my child(ren), ___________________ is (are) physically able to participate in The West Island Soccer School .  I voluntarily assume all risk of any accident or injury to my child which may arise out of his/her/their participation in this program: here forth intending to release The West Island Soccer School and any personnel associated with this program from any liability that may result from his/her/their participation.			St-Lazare/ Saddlebrook
Signature		Date
Thank you and Welcome to The WISS !!!			Date