FIREWEED Ministry Soccer Camp Registration

SOCCER CAMP REGISTRATION

PARENT INFORMATION
Parent's Name *

First Name Middle Name Last Name
Parent's Email *
example@example.com
Parent's Cell Number *
Parent's Address *

Street Address

Street Address Line 2

City State

Zip Code

SOCCER CAMP REGISTRATION

CHILD INFORMATION
Child's Name

First Name Last Name
Does your child have a nickname they prefer?
What is your child's Date of Birth *

Month Day Year
Date
Unique Needs
Does your child have any food allergies? *

YES NO
Please tell us about your child's food allergies *
Does your child have any medical conditions we need to know about? *

YES NO
Please tell us about your child's medical condition. *

FIREWEED MINISTRY INC.

PO BOX 770195

EAGLE RIVER, AK 99577

MEDICAL CONSENT

I, {parentsName}, hearby give my permission for {childsName} to participate in any ministry sponsored by Fireweed Ministry Inc. I assure the leadership that he/she is in goog health and able to participate. Any medical conditions are disclosed to the Fireweed Ministry Inc leadership on the online registration.

I give my consent for medical treatment by an attending physician or medical center deemed necessary in the even of an emergency. I agree to use my own medical insurance in the event of medical treatment.

A parent or legal guardian of {childsName} must complete the following information.

Do you agree with the MEDICAL CONSENT above for {childsName}
*

I AGREE I DO NOT AGREE
NAME of Parent or Legal Guardian providing approval for MEDICAL CONSENT: *
EMAIL of Parent or Legal Guardian providing approval for MEDICAL CONSENT: *
example@example.com
CELL of Parent or Legal Guardian providing approval for MEDICAL CONSENT: *

Assumption of Risk and Hold Harmless Agreement (AoR & HHA)
In consideration of being allowed to participate in the Program of Fireweed Ministry Inc., and with due consideration for all risks involved, the undersigned participant and parent(s) or guardian(s) hereby:
1. Personally assume all risks which may be involved in participation.
2. Waive the right to make any claims for personal injury, or damage to or loss of property, against FIREWEED MINISTRY Inc., or any of its chapters or affiliates and their personnel.
3. As parents or guardians, agree to hold harmless FIREWEED MINISTRY Inc., its chapters or affiliates and their personnel from all claims which may be made on behalf of the participant for personal injury, or damage to or loss of property.
All of the provisions of this agreement shall continue to apply the entire time participant is involved in FIREWEED MINISTRY INC Ministries during the period of one (1) year from date form was completed.

A Parent or Legal Guardian of {childsName} must complete the information below:

Do you agree with the FIREWEED Ministry ASSUMPTION OF RISK and HOLD HARMLESS AGREEMENT:
*

I AGREE I DO NOT AGREE
NAME of Parent or Legal Guardian providing approval: *
EMAIL of Parent or Legal Guardian providing approval: *
example@example.com
CELL # of Parent or Legal Guardian providing approval: *

We are excited to have your family participate in the FIREWEED Ministry Soccer Camp at First Baptist Church Palmer, June 21-24, 11:00 am - 4:00 pm.

If your information is complete please press the SUBMIT button below. If you have additional children you would like to register please return to the form and complete for each child.
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