kids summer soccer camp registration form - Pickerington

KIDS SUMMER SOCCER CAMP REGISTRATION FORM Player’s Name _____________________________ Address __________________________________ City, Zip ___________________________ Cell phone#__________________________ Emer. phone#___________________________ Grade entering fall 2015-2016_________________ Current Age ____ Parent’s information Mother’s Information

Father’s information

Name: ______________________

Name: _____________________________

Address, City Zip________________________

Address, City Zip______________________

Phone#_______________

phone#_______________

Email: __________________________________ email: ________________________________ Circle T-Shirt size:

S

M

L

AS

AM

Waivers of Damage Parents or guardians are required to sign a release of Pickerington Central High School and its employees from any personal injury sustained by the athlete during the camp. You are also stating that your child is physically fit to participate in the camp and that you child is covered by medical insurance. Please listed any medical concerns we should know about below: Medical Concerns____________________________________________________________________ (Parent’s signature)

Date

Make checks payable in amount of $50 to Pickerington Central Athletics/Soccer Any questions, please email Denise Scaduto- Sidekicks ([email protected]) Mail to:

Pickerington Central H.S (Attn:Boys/Girls Soccer), 300 Opportunity Way, Pickerington, Ohio 43147