Soccer Camp

Webb Soccer Camp

Webb's Soccer Camp is an opportunity for any soccer player to enhance his or her overall skill level. Kevin Moore, Varsity Boys' and Girls’ Soccer Coach, League Coordinator at Shelbyville Indoor Soccer Indoor Facility, and Director of Coaching at Shelbyville Football Club will be leading the camp.

For more information, contact Coach Kevin Moore, kmoore@webbschool.com

July 14-16
Co-ed, rising 2nd-5th grade students

July 21-23
Co-ed, rising 6th-9th grade students

Monday: 9:00 a.m. - 1:00 p.m
Tuesday: 9:00 a.m - 1:00 p.m.
Wednesday: 9:00 a.m. - 11:00 a.m.

Cost: $100
I would like to register for the following: *

Webb Soccer Camp (July 14-16: Grades 2-5) Webb Soccer Camp (July 21-23: Grades 6-9)
Child's Full Name *

First Name Last Name
Child's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Child's Age *
Child's Gender *
Child's T-Shirt Size *
Child's Birthdate *

Month Day Year
Parent/Guardian 1 *

First Name Last Name
Parent/Guardian 2

First Name Last Name
Cell Phone Number *

Area Code Phone Number
Home Phone Number

Area Code Phone Number
Work Phone Number

Area Code Phone Number
E-mail *

Medical Report to be completed by Parent or Guardian
Does your child have any current medical conditions, concerns, or limitations of which we need to be aware?
List any medications that will need to be administered by Webb School personnel. Please provide medication name and dosage information.
Does student use an inhaler?

Yes No
If an inhaler is used, indicate how often
If yes, please be sure the Student/Camper has one with him or her during the duration of his or her time at The Webb School. Please make the Instructor and/or Nurse aware of where it is located.
Please list any food/medication/environmental allergies?
Does your child require and Epi-Pen?

Yes No
Are there any over the counter medications (ex: Ibuprofen, Nyquil, Mucinex) you do NOT want your child to take?
If yes, please explain above.
Does your child have any special dietary needs?
If yes, please explain above.
Are there any other physical/mental/emotional factors we should be aware of in caring for your child?

Medical Insurance Information
Name of Insurance Company
Group #
Policy Holder Name
Policy Holder ID
Policy Holder DOB

Month Day Year
Date
Please upload a picture of the Front and Back of Your Insurance Card

Browse Files

Cancel of
Alternately you can send pictures of your Insurance Card using SMS/iMessage from your phone. Create a new message to sdouglas@webbschool.com and attach the images.

Permissions Release

Parent hereby authorizes and consents to Student’s participation in all School activities, including, but not limited to, athletics/physical education activities, any School-sponsored trip away from the School, including the utilization of any transportation supplied by the School (such as buses) for such activities, unless the School receives timely written notice to the contrary. Although it is understood that the School and its representatives intend to take reasonable precautions with respect to all activities, Parent understands that the participation of Student in such activities involves a certain element of risk, Parent releases and holds The Webb School and its agents, administrators, managers, employees, trustees and representatives (“Released Parties”) harmless from any and all liability and/or claims, suits, property damage, illness, accidents, injury, or loss whether arising before, during, or after such activities which are not the result of willful misconduct of any of the Released Parties and agrees not to sue any Released Party for any claims released herein.
Consent *

I agree with the Permissions Release
Medical Authorization

If, in the opinion of a properly licensed and practicing physician, Student needs medical or surgical services which require Parent’s pre-authorization or consent, Parent hereby authorizes, appoints, and empowers the School to act as Parent and furnish such consent on Parent’s behalf. Parent confirms that it is Parent’s desire that Student be furnished with such medical or surgical services as soon as reasonably possible after the need arises. Parent hereby releases and holds the School harmless from any liability which might arise from the giving of such consent. Parent agrees to reimburse the School for any medical expenditure made on Student’s behalf.
Consent *

I agree with the Medical Authorization
Consent to On Site Medical Care

Parent hereby authorizes the School to supply medical care as needed for Student (including administration of allergy medications, Epi-Pens, etc. according to the Student’s prescription from a licensed practitioner) or other minor medical care as determined to be appropriate by the School nurse. Parent hereby releases and holds the School harmless from any liability which might arise from the provision of such medical care.
Consent *

I agree with the Consent to On Site Medical Care
Media Release

I give The Webb School permission to use photographic/electronic images of my child to promote The Webb School in any electronic or print media, news/photo releases, advertisements distributed to media outlets, internal/external school publications, social media and marketing materials, (i.e.: The Webb School Facebook Page, Webb Beat E-Newsletter, etc.).
Consent *

I agree with the Media Release
Electronic Signature

I hereby attach my electronic signature to and agree to the terms and conditions of the terms above. I understand that my electronic signature is legally binding and may not be invalidated solely on the basis that my signature was electronically obtained.
Parent/Guardian Name *

First Name Last Name
Date *

Month Day Year
Date
Parent/Guardian Name

First Name Last Name
Date

Month Day Year
Date

Soccer Camp Registration

Webb Soccer Camp $ 100.00

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Soccer Camp Options

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Webb Soccer Camp

July 14-16 Co-ed, rising 2nd-5th grade students

Monday: 9:00 a.m. - 1:00 p.m Tuesday: 9:00 a.m - 1:00 p.m. Wednesday: 9:00 a.m. - 11:00 a.m. Cost: $100

Medical Insurance Information

July 14-16
Co-ed, rising 2nd-5th grade students

Monday: 9:00 a.m. - 1:00 p.m
Tuesday: 9:00 a.m - 1:00 p.m.
Wednesday: 9:00 a.m. - 11:00 a.m.

Cost: $100