2024 Firebird Soccer Camp

2024 Firebird Girls Soccer Camp

Grades 1st-9th June 17-20, 8:30am-10:30/11:30am
Athlete Information
Paid
Athlete's Name*

First NameLast Name
Fall 2024 Grade*
School*
T-Shirt Size *
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Number*

Area CodePhone Number
Graduation year *
Student ID Number (Lakota Students only)
Guardian Name
Guardian Name
Club Team
Notes
Please read the LAKOTA RELEASE OF LIABILITY/ INFORMED CONSENT/ ASSUMPTION OF RISK WAIVER which is listed on the following link. http://s3.amazonaws.com/vnn-aws-sites/172/files/2017/03/d4c3bcd07ea3b63f-Release-of-Liability-.pdf

The following questions refer to this form.
Player: By typing your name, you are agreeing to the terms of the Lakota Release of Liability Form.*
Parent: By typing your name, you are agreeing to the terms of the Lakota Release of Liability Form.*
Is the student covered by a medical insurance policy?*
If yes, please list insurance company name and policy number.*
West HS Girls Soccer Camp Grades 1st-9th $100

*Correct t-shirt Size cannot be guaranteed on registration after May 17th, but we will do our best!

PAYMENT CHANGES:

**Please pay via EZ-Pay or by check to Lakota West HS, ATTN: Lakota West Girls Soccer**

Lakota West Girls Soccer c/o

Lakota West HS

8940 Union Centre Blvd.

West Chester, OH 45069

Questions?

Please contact Brigit Reder at brigitreder12@gmail.com
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2024 Firebird Girls Soccer Camp