Summer Camp Registration

SUMMER CLINICS REGISTER NOW

Player Information:

Player Full Name *

Player Date Of Birth//

Player Gender *

Player Address

Player Contact Information *

Parent/Guardian Information:

Parent/Guardian Full Name (copy) *

Parent/Guardian Email *

Parent/Guardian Phone

Parent/Guardian Relationship to player

Emergency Contact Information:

Emergency Contact Full Name *

Emergency Contact Information *

Emergency Contact Relationship to player (copy)

Medical Information:

Allergies

Existing Medical Condition

Primary Care Physician Contact Information

Insurance Information

Consent and Waivers:

Medical Treatment Authorization

Liability Waiver/Release

Consent for Participation

Additional Information:

Previous Soccer Experience

Preferred Position

Jersey Size

Date/ Time of Clinic

Date/ time of clinic,

Date

Time

Player Gender (copy) *

Others

Player Information:

Parent/Guardian Information:

Emergency Contact Information:

Medical Information:

Consent and Waivers:

Additional Information:

SUMMER CLINICS REGISTER NOW

Player Information:

Parent/Guardian Information:

Emergency Contact Information:

Medical Information:

Consent and Waivers:

Additional Information:

Date/ Time of Clinic

Programs

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