Manettte Community Church Soccer Camp

July 15-19, 2024 - 9:30 am - 12:20 pm
Manette Park Playground

REGISTRATION

Student Information

First Name

Last Name

Age

Grade Entering

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Gender

Phone Number

Does the student have any medical conditions that may require special attention during the Soccer Camp?

Medical Conditions / Allergies

Prescription Medications

Parent or Guardian Information

First Name

Last Name

Emergency Contact Number

Email

Insurance & Medical Consent

Insurance Company

Policy/Group Number

Policy Holder

Student's Birthdate

If it should become necessary for my child to receive medical treatment for any reason, the staff will make every effort to contact the person listed in this form as the Emergency Contact person. If we are unable to reach this person and need to get treatment for the student, I give my consent to all medical, surgical, diagnostic and hospital procedures prescribed by a physician to safeguard my child’s health.

Parent or Guardian Signature

Student Agreement

I understand and have explained to my child that attendance at Soccer Camp is a privilege, not a right and agree to the following behavior:

Student will abide by the rules set by the staff.

Yes

Student will not use foul language or be disruptive.

Yes

Please note: In case of inclement weather, Soccer Camp may move to Manette Community Church on the corner of E. 13th & Hayward Ave, 2 blocks west of Manette Park Playground.