Medical release
This form is filled out at registration and is usually kept
by the coach in case of medical emergency. The form must be
completed, even if the parent intends to attend all practices and
games.
I hereby give my consent for all medical care prescribed by a duly Licensed Doctor of Medicine for ____as his/her Parent or legal guardian. This care may be given under whatever conditions________________ are necessary to preserve the life, limb, or well-being of my dependent.
PLAYERS
| LAST NAME | FIRST NAME | MI |
| BIRTHDATE _______________ | Date: _____________ | Address: ________________ |
| Phone: _________________ | City: __________________ | |
| Mail Code | URL | Gender |
| Parent/Guardian (Please Print) _____________________________ |
| Person To Notify in Emergency _____________________________ |
| Phone: __________________________ |
| Doctor To Notify in Emergency __________________________ |
| Hospital Preference, If Any ___________________________ |
| City: _____________________________ |
| List Any Medical Problem or Prohibition Player Has ________________________________________ |
| MEDICAL RELEASE NOTARY |
| My name __________________________________ |
| Subscribed and sworn to me this day of ______, 2004. |
| My Commission Expires: ___________________ |
Option 1 - Send money through Western Union to Honduras to CODET to La Esperanza, Intibuca, Honduras
Option Two - Send copies of the application by certified, registered mail, or DHL with payment to CODET, S de R L, Barrio El Morera, Farmacia Galencia, Frente Bazar Reyna, La Esperanza, Intibuca, Honduras
Because of internet insecurity in many African countries, no applications can be sent by email. ALL APPLICATIONS MUST BE ACCOMPANIED BY PAYMENT. SENDING APPLICATIONS AND PAYMENT BY DHL IS PROBABLY YOUR BEST OPTION.
Option Three (the best, safest & fastest option) Paying By Wire Transfer
Wire transfers must be sent to:
Wells Fargo Bank, N.A.
San Francisco, CA.
Routing Transfer Number (RTN) 121000248
Account # 827 522 7026
Note that your bank will charge you a fee for making this kind of transaction. This transaction fee must be paid by the party making the transaction, and not subtracted from the amount being transferred to the AfroCarib Cup, La Ceiba Football Academy, RED de AfroHeritage Footballers, ISAI or CODET. This is for wire transfers only, do not use direct deposit because we will have no way of tracking your payment.
For All Programs In order for your team's application to be processed, a team application fee and individual visa fees of US$175 each person must be received by CODET. |
Want to see this forward looking team grow? We are seeking to build our own stadium where Member/Sponsors can enjoy themselves when they come to Honduras. Become a friend and get special treatment. Email Dr. Cross at exportfacs@aol.com for more information.
Want to know more? You can get all the fun of ownership and the benefits of belonging to this world Class team by becoming a sponsor. Want to be on the field with this team? Email us at exportfacs@aol.com or honducopa@yahoo.com
Dr. Carol Cross or Dr. Ramon Dario Argueta
Barrio El Morera, Frente Bazar Reyna
La Esperanza, Intibuca, Honduras
Dr. Argueta: Telephone 504-783-0054 or 504-398-9554
Dr. Cross: 504-783-0421
 2005-2006 Honduras Soccer Team Membership & Sponsorship Available For Enrollment June 1,
2005. Make Sure You Don't Lose Your Chance. Send In
Your Deposit Now!
Belong To The Team As A Member Or Sponsor The Team As A Marketing Partner. We Promise
To Show You A Good Time! |
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Dr. Cross Can Be Reached In Honduras after July 1, 2005 Mailing Addresses after July 1, 2005 - Dr. Carol Cross, C/O Doña Aleja de Valdivieso, Barrio El Centro, La Esperanza, Intibuca, Honduras exportfacs@aol.com or honducopa@yahoo.com Telephone 504 - 783 - 0421 You May Also Contact Dr. Cross Through Doña Silvia Palencia y Hijos, Hotel La Esperanza, La Esperanza, Intibuca, Honduras Telephone 504 - 783-0068 Through Dr. Ramon Dario Argueta, CODET, Barrio El Morera, Frente Bazar Reyna, La Esperanza, Intibuca, Honduras, Telephone 504-783-0054 Email honducopa@yahoo.com The International Institute of Soccer Tourism Is Opening in La Esperanza, Honduras in September 2005. IIST Understands The Problems of Soccer Tourism in Developing Countries. IIST Supports Soccer Tourism Professionals in Central America, South America, the Caribbean Islands, Africa and Asia |
ISAI Contact Information
Dr. Carol Cross, Director , The International Sports Adventure Institute, Inc.
Supporting Soccer Based Development Through Soccer Tourism, Honduras Soccer Camps, Intibuca International Youth Tournament, AfroCarib International Youth Tournament, the Copa Weshemisphere Friendlies and the LigaAmericás Soccer Mastery Academy. AfroHeritage Soccer Players - Join the RED de AfroHeritage Footballers. AfroHeritage Soccer Players - Play in the African/Caribbean Youth Soccer Tournament in November 2005. Learn to Play World Class soccer in the La Ceiba Football Academy for Elite Players Opening in June 2005 in Honduras. Email to exportfacs@aol.com
Soccer is our Passion, Our Love, and Our Focus at ISAI. We work with Youth At Risk in Arizona and Honduras through our support for Soccer For Life, Inc, a a public charity and 501 (C) 3, tax exempt, non profit organization. Subscribe to free Soccer Mastery newsletter based on the LigaAmericás Soccer Mastery Academy opening in 2005 in La Esperanza Honduras in La Esperanza, Honduras. Send email to exportfacs@aol.com. Play in the 2nd Torneo Internacional Intibucana "Soccer Against Global Warming" in July 2005.
Home Page: www.satglobal.com/soccer_entry.htm Email to exportfacs@aol.com or honducopa@yahoo.com
Phone : Before July 15, 2005 - 602-564-9241
After July 15, 2005 - 011-504-783-0421
International Sports Adventure Institute, Inc., DBA ISAI, has no liability for contents or goods on the Internet except as set forth in the Terms and Conditions Of Services.
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Copyright © 2004 Carol Cross: Document # - 1031 - Consent For Medical Treatment
