Soccer Mini Camp at the Bay Terrace Center

*Please note: Monday, Tuesday and Wednesday are at capacity for registration.

We’re so thrilled to share that Coach Dane is hosting a special Soccer Mini Camp at our Bay Terrace Center (212-00 23rd Avenue, Bayside, NY) from Monday, August 31st through Friday, September 4th, running daily from 9:00 AM to 4:00 PM. This five-day intensive camp includes indoor drills, skills and scrimmages, as well as daily swim at the Bay Terrace Pool. This program is for children ages 6-11, and will be led by Dane Warren, a Premier Certified Soccer Coach (the highest level of soccer coaching certification!) with the United Soccer Coaches Association.

$80 per day for Commonpoint Queens Members (including pool clubs and summer camp), $85 per day for non-members. We are also offering special Early Stay (8:00 AM to 9:00 AM – $10 per day) and Late Stay (4:00 PM to 5:00 PM – $10 per day) options.

For more information please contact Dale Stark at 718-268-5011 ext. 501 or by email at [email protected]org

Camper Name*
Camper Age as of August 1, 2020*
Camper Date of Birth*

Date Format: MM slash DD slash YYYY
Camper's Gender*
Grade Entering in September*
Camper's School*
What Camp did your child attend this Summer?*
Does your child have any special medical conditions or special needs that we should be aware of? i.e. food allergies, asthma, diabetes, heart conditions.*
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Parent/Guardian Name*
Parent's Date of Birth*

Date Format: MM slash DD slash YYYY
Parent/Guardian Cell Phone*
Parent/Guardian Business Phone*
Parent/Guardian Email*
Parent/Guardian Name 2
Parent/Guardian Cell Phone 2
Parent/Guardian Business Phone 2
Parent/Guardian Email 2
Emergency Contact Name*
Emergency Contact Relationship*

Cannot be a parent
Emergency Contact Phone 1*
Emergency Contact Phone 2*
My child will attend the following days:*
- Thursday, September 3
- Friday, September 4
My child will need Early Stay the following days:
- Thursday, September 3
- Friday, September 4
My child will need Late Stay the following days:
- Thursday, September 3
- Friday, September 4
Credit Card Type*
Credit Card Number*
Credit Card Expiration*
Credit Card CVN*
Covid 19 Waiver*
I agree

Read this document carefully and in entirety. By signing the agreement. You give up your right and the named minor’s right to bring a court action to recover compensation or obtain any other remedy for any personal injury however caused by contracting COVID-19 arising out of the named minor’s participation in Commonpoint Queens activities.

I, in my legal capacity as the parent/guardian of the minor named below, do hereby acknowledge and agree that participation in camp and other Commonpoint Queens activities comes with the inherent risk of contracting Coronavirus, COVID-19. I understand that COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Commonpoint Queens programs or accessing Commonpoint Queens facilities could increase the risk of contracting COVID-19. Commonpoint Queens in no way warrants that COVID-19 infection will not occur through participation in Commonpoint Queens programs or accessing Commonpoint Queens facilities.

In consideration of my minor child’s participation in Commonpoint Queens activities, I, as the parent/guardian of the minor named below, agree to release and on behalf of myself and the minor named below, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE Commonpoint Queens, its officers, directors, employees, volunteers, agents, representatives and insurers (“Releasees”) from any causes of action, claims, or demands of any nature whatsoever
including, but not limited to, claims of negligence, which I, the named minor, my heirs, representatives, executors, administrators and assigns may have , now or in the future against Commonpoint Queens on account of personal injury, death or accident of any kind, arising from COVID-19 as a result of the use of Commonpoint Queens facilities/equipment or participation in Commonpoint Queens programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees.

I hereby certify on behalf of myself and the named minor that I have full knowledge of the nature and extent of the risks of contracting COVID-19 inherent in participation in Commonpoint Queens activities and that, I, on behalf of myself and the named minor, am voluntarily assuming said risks. I understand that I and the named minor will be solely responsible for any loss or damage, including personal injury, or death, the named minor sustains while participating in Commonpoint Queens activities and that by signing this agreement I, on behalf of myself and the named minor, HEREBY RELEASE Releasees of liability for such loss, damage, or death.
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