Soccer Camp 2026 Registration
July 20-23, 2026
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How many kids are you registering?
*
Please Select
1
2
3
4 or more
Child 1 Name
*
First Name
Last Name
Child 1 Age
*
Child 1 Grade
*
Please Select
1
2
3
4
5
6
7
Please enter the grade your child will be this fall
Child 2 Name
First Name
Last Name
Child 2 Age
Child 2 Grade
Please Select
1
2
3
4
5
6
7
Please enter the grade your child will be this fall
Child 3 Name
First Name
Last Name
Child 3 Age
Child 3 Grade
Please Select
1
2
3
4
5
6
7
Please enter the grade your child will be this fall
Child 4 Name
First Name
Last Name
Child 4 Age
Child 4 Grade
Please Select
1
2
3
4
5
6
7
Please enter the grade your child will be this fall
Child 5 Name
First Name
Last Name
Child 5 Age
Child 5 Grade
Please Select
1
2
3
4
5
6
7
Please enter the grade your child will be this fall
Child 6 Name
First Name
Last Name
Child 6 Age
Child 6 Grade
Please Select
1
2
3
4
5
6
7
Please enter the grade your child will be this fall
Medical Release Agreement
All information from here to the end of the registration form is for all children listed above.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Specific Needs Your Child May Have:
Child Pickup
Please list the names of up to three individuals that have permission to pick up your child(ren) from soccer camp. NOTE: children will only be released to these people. If anyone else attempts to pick up your child, we will call the emergency contact for confirmation. The emergency contact name is already assumed to be a child pickup person.
Child Pick Up Permission 1
*
First Name
Last Name
Child Pick Up Permission 2
First Name
Last Name
Child Pick Up Permission 3
First Name
Last Name
Do you authorize the soccer camp staff to seek medical attention for your child, in the event that the emergency contact cannot be reached? *Note: In case of injury, the soccer camp staff will call the emergency contact before any medical attention is given. We will seek medical attention ONLY if absolutely necessary AND the emergency contact cannot be reached. By answering "Yes" below, you agree that the soccer camp staff and Walnut Park Baptist Church is not responsible for any injuries that may occur.
*
Yes
Do you authorize the soccer camp staff to publish pictures that may include your child(ren)?
*
Yes
No
Submit
Should be Empty: