Each player, coach or participant must bring their own insurance with them. ISAI will not be responsible for medical needs or problems but will enable players to be taken to hospitals if needed, with all responsibilities for player, coach or other participant.
This completed form will enable health facilities and ISAI staff to provide prompt care to your minor son or daughter
All Areas of This Form Must Be Completed Prior to Tournament Participation
| Name | Social Security # | Passport Number |
| Birth Date | Guardian’s Name/Relationship | ______Yes Allergic Reactions (drugs, food, asthma…) |
| ____No Allergic Reactions (drugs, food, asthma…) | ______Yes Taking any medication at this time | ______No Taking any medication at this time |
| If yes, Describe Allergy or Medication |
In Case of Emergency
| Date of last tetanus toxoid ___________ | Father
Home Telephone _________________ |
Father
Work Telephone __________________ |
| Mother
Home Telephone ________________ |
Mother
Work Telephone ________________ |
Other
Emergency Number (List person to contact) __________________ |
| Your
Insurance Company ________________ |
Policy
# _________________ |
Name
of Policy Holder __________________ |
| Any
instructions regarding your insurance _________________ |
Comments
_________________ _________________ |
I/We, the undersigned hereby certify that I (we) am (are) the
parent or legal guardian of the player. I hereby give permission
for the staff of the tournament to seek during the period of the
tournament appropriate medical attention for the player and for
medical attention to be given and for the player to receive
medical attention in the event of accident, injury, or illness. I
(we) will be responsible for any and all costs of medical
attention and treatment, except for that covered by the
tournament’s excess medical coverage policy.
I/We, the undersigned, for ourselves and as the guardian’s
of
Player’s Name _______________________________________
understand that football/soccer is
an active, physical sport, and that injuries can take place
during play. I/We also understand that there will be a number of
children attending the tournament, there will be a limited number
of coaches and/or counselors, and that our child can not receive
individualized attention and supervision all of the time. I/We
understand that, as with any sport, injuries can occur, and we
hereby acknowledge that our child is physically fit and mentally
capable of participating in soccer tournament and Academy
activities.
I/We, represent that I/we have sought the opinion of our
child’s pediatrician,
_________________________________, and he concurs that,
Name of Player’s Physician
_______________________________
Player's Name
is fully capable of safely
engaging in these activities. I/We also understand that it is
my/our responsibility in caring for the Player listed above, and
to be assured that he/she is fully capable of engaging in this
sport’s activity, and I/we are confident that he/she is able
to engage in such a sport.
I/We, the undersigned for ourselves, our heirs, executors and
administrators, waive, release and forever discharge Dr. Carol
Cross and ISAI, Inc and its staff, officers, agents, employees,
representatives, successors, and assign of and from all rights
and claims for damages, injury, or loss to person or property
which may be sustained or occur during participation in
tournament activities or while at the tournament, whether or not
damages, injury, or loss is due to negligence.
Signature of Parent or Guardian
___________________________________
Date _____________
Please fill our both sides of this form and return it with your deposit to reserve your space at the tournament.
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
Applications can be sent by email. However it is more secure to send APPLICATIONS ACCOMPANIED BY PAYMENT. SENDING APPLICATIONS AND PAYMENT BY DHL IS PROBABLY YOUR BEST OPTION.
Option Three - Paying By Wire Transfer
Email to honducopa@yahoo.com or exportfacs@aol.com for information on sending wire transfers.
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.
Option
Four - Paying Through PayPal
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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Copyright © 2004 Carol Cross:
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.
For information on this page or problems contact: Webmaster: webmaster@satglobal.com
Copyright © 2004 Carol Cross: Document # - 1012 - Health Release
