KYL TEAM SUMMER CAMP REGISTRATION FORM

KARE YOUTH LEAGUE SUMMER CAMP REGISTRATION FORM

Our KYL Team Summer Camps are only available to Kare Youth League members enrolled in the SUMMER SOCCER PROGRAM.
Great Start & C Boys Camp - June 13 ($60)B, A & AA Boys Camp - June 13 & 14 ($100)Big Ten Boys San Diego Trip - June 24 - 27 ($350)4th, 5th & 6th Grade Girls Camp - June 25 - 28 ($180)1st, 2nd & 3rd Grade Girls 2-Day Camp - July 11 & 12 ($100)1st, 2nd & 3rd Grade Girls 1-Day Camp - July 11 ($60)Royal Friends Camp Saturday - July 11 ($60)
Great Start & C Boys Camp on Saturday, June 13 ($60)B, A & AA Boys Camp from Saturday, June 13 to Sunday, June 14 ($100)Big Ten Boys San Diego trip Wednesday, June 24 to Saturday, June 27 ($350)D1 & D2 Girls Camp from Thursday, June 25 to Sunday, June 28 ($180)D3 Girls Camp from Friday, July 10 to Saturday, July 11 ($100)Royal Friends Camp Saturday, July 11 ($60)
501 - Great Start & Cs

502 - B & As

504 - AAs

505 - Big 10 @ Mount Kare

507 - Big 10 San Diego

508 - Royal Friends

509 - D3

510 - D2

511 - D1
B DivisionA DivisionAA Division
Child's Name*

First NameLast Name
Child's Birthdate*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Team*
KYL Leader*
IrwindaleCovina
IrwindaleCovina
Parent's Name*
Parent's Cell Phone*
Format: (000) 000-0000.
Home Phone*
Or Other Parent/Guardian PhoneFormat: (000) 000-0000.
Parent's Email*

Confirmation Emailexample@example.com
Name of Emergency Contact*
Notify if parents cannot be reached
Emergency Contact Cell Phone*
Format: (000) 000-0000.
NoneYes
(if yes, please list)
Date of last Tetanus Vaccination

MonthDayYear
Explain any sickness
(subject to headaches, asthma, earaches, etc.) and/or physical limitations
Any limitations in activities?
Eating habits
What has not been covered that we should know about your child to understand and help him/her most
yesno
Health Insurance Company*
Policy or member number*
1. I will not allow my child to go to camp if, to the best of my knowledge, my child has, or is immediately prior to camp exposed to any communicable diseases.

2. I hereby agree to hold harmless Kare Youth League, its employees, agents and representatives and volunteer assistants for any and all problems, adverse reactions or other medical problem(s) resulting from or due to the medications, medical administration or applications given to my child. By initializing here, I agree I have read this paragraph and waive any and all rights to seek redress from Kare Youth League, its employees, agents, representatives and volunteer assistants.
Please enter your Initials Below for Item #2*

Clear
3. I will not allow my child to bring any of the following items: radio, ipod, mp3, cell phone, electronic gizmo of any kind, knife, or snacks.

4. In case of sickness or accident, Kare Youth League has my authorization to secure such medical attention as is deemed necessary if unable to communicate with me immediately.
Signature of parent or guardian

Clear
Item Key
Member ID or Name
Date

MonthDayYear
Date
Amount Due

Amount Due*

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

KARE YOUTH LEAGUE SUMMER CAMP REGISTRATION FORM