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2014 Medical Release Form: Complete and return this form with application. Consent to Medical Treatment & Release of Liability (Read this before signing below) In consideration of being allowed to participate in this cam
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Document Date: 2014-05-02 01:03:04

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City

Ft Myers / Myers / /

Currency

USD / /

Facility

Camp Dates ELITE CAMP / University Soccer Office / Alico Arena / Florida Gulf Coast University / Florida Gulf Coast University campus / University Attn / JR. ELITE CAMP / FGCU Boulevard South Fort / DAY CAMP / Club Team / Airport Shuttle / /

Organization

Florida Gulf Coast University Soccer Office / Board of Regents of the State of Florida / Florida Gulf Coast University / /

Person

Jim Blankenship / /

/

Position

attorney / Goalkeeper / personal representative / player / soccer player / /

ProvinceOrState

Florida / /

SportsLeague

Division I / /

URL

WWW.FGCUSOCCER.COM / /

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