Kicks4Kids 2023 Registration Form

The Soccer camp will be on the dates:

Mon-Thurs

Drop off 9:00 a.m Pick up 10:30 a.m

Session 1: June 12th - June 22nd

Session 2: July 31st - August 10th

Session 1

Session 2

Athlete Information

Athlete's Name

First NameLast Name

Birth Date

MonthDayYear

Age

Gender

MaleFemale

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

Emergency Information

Emergency Contact's Name (can be parent)

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Kicks4Kids during the selected camp. In exchange for the acceptance of said child’s candidacy by Kicks4Kids, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Kicks4Kids, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Kicks4Kids, including all coaches and affiliates. There is a risk of being injured that is inherent in all sports activities, including soccer. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Signature

Clear

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Kicks4Kids 2023 Camp Registration

Session Sign-up