Register online or click here to download the form and mail it to us.
   
  Brazil Programs Registration Form
Registering As:
Part of a Team
 Team Name:
Individual
Registering For:
Samba Tour
Jinga Residential Camp
 Champions Camp
Personal Details:
*
Name (as stated in passport) :
*
Gender:
Date of Birth:
 Age:
*
Address:
*
*
 *
Zip:
State:
City:
*
Email:
*
Parents/Guardians Name:
*
Cell:
Phone: (h)
 Work:
*
T-shirt Size:
Shorts Size:
Playing Experience:
Name of Your Current Team:
*
League, Division, Age Group:
*
*
Coach's Name and Phone Number:
*
 Position:
Soccer Accomplishments:
Emergency Contact In the U.S. while on the tour:
*
1st: Name:
 Cell:
Relationship:
*
2nd Name:
Cell:
 Relationship:
Medical Form:
*
 List any medical conditions:
*
List any allergies:
*
Health Insurance Company and Phone:
Policy Number:
*
Prior to departure, we request that you submit insurance card copy and passport copy
SOCCER IS A PHYSICAL SPORT WHICH MAY RESULT IN INJURIES. BY YOUR ELECTRONIC SIGNATURE, YOU AGREE TO ALLOW YOUR
CHILD TO PARTICIPATE IN THIS PROGRAM. BRAZILIAN SOCCER ACADEMY, ITS AGENTS & EMPLOYEES & OFFICERS ARE RELEASED
AND DISCHARGED FROM ALL CLAIMS, DEMANDS, ACTIONS, JUDGMENTS WHICH THE UNDERSIGNED’S HEIRS, EXECUTORS,
ADMINISTRATORS OR ASSIGNEES MAY HAVE OR CLAIM AGAINST BRAZILIAN SOCCER ACADEMY, FOR ALL PERSONAL INJURIES KNOWN
OR UNKNOWN, AND INJURIES TO PROPERTY, REAL OR PERSONAL, CAUSED BY OR ARISING OUT OF THE AFOREMENTIONED SPORTS
ACTIVITIES OR ANY OTHER ACTIVITIES WHICH ARE INCIDENTAL OR NECESSARY THERETO. THE UNDERSIGNED AUTHORIZES
BRAZILIAN SOCCER ACADEMY, ITS EMPLOYEES AND OFFICERS TO ARRANGE FOR ANY EMERGENCY MEDICAL CARE OR TREATMENT
FOR THE ENROLLED CHILD WHICH MAY BE REQUIRED AS A RESULT OF PARTICIPATING IN THE AFOREMENTIONED ACTIVITIES AND
AGREE TO HOLD THE CAMP, EMPLOYEES, OFFICERS, FREE AND HARMLESS FOR ANY CLAIMS., DEMANDS OR SUITS FOR ANY INJURY
OR COMPLICATIONS WHATEVER WHICH MAY RESULT FROM SUCH TREATMENT. I/WE AGREE TO BE RESPONSIBLE FOR ANY AND ALL
COSTS THAT MAY INCUR AS A RESULT OF TREATMENT AND CARE.

PLAYER AND PLAYER’S PARENTS OR GUARDIAN AGREE THAT BRAZILIAN SOCCER ACADEMY SHALL HAVE THE RIGHT TO TAKE OR
CREATE PHOTOGRAPHS (WHETHER STILL, MOTION OR TELEVISION) AT ANY TRAINING OR MATCHES. PLAYER AND PLAYER’S PARENTS
OR GUARDIAN AGREE THAT BRAZILIAN SOCCER ACADEMY AND ITS PARTNERS MAY USE SUCH PICTURES OR LIKENESSES FOR THE
PURPOSE OF PROMOTING AND DEVELOPING THE ORGANIZATION.
*
I HAVE READ THIS RELEASE, UNDERSTAND ITS TERMS AND EXECUTE IT VOLUNTARILY & WITH FULL KNOWLEDGE OF ITS
SIGNIFICANCE.
Electronic Signature:
Questions or comments:
Thank you for registering online. You must submit by mail passport copy, health
insurance card copy, deposit of USD$200. We will email you an invoice within 7
business days.  In order to secure a spot in any of the programs in Brazil, all
necessary paperwork with deposit  must be received within 14 days of filling out
this form.