Soccer Camp Registration Form

Higher Power Soccer Camp

July 28th - August 1st, 2025, 5:30pm-8:00pm. Kids: Age 4 - Grade 5
Camper Sign-Up
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade
MaleFemale
T-Shirt Size (Please define "Youth" or "Adult" size)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I, the undersigned parent or legal guardian of the above-named minor (the "Participant"), hereby give permission for the Participant to attend and participate in the Youth Soccer Camp (the “Higher Power Soccer Camp”) hosted by Tri Lakes Baptist Church.

I understand that participation in soccer and related camp activities involves inherent risks, including but not limited to physical injuries such as sprains, fractures, concussions, or other serious injuries. I voluntarily assume all such risks on behalf of the Participant.

In consideration of the Participant being allowed to participate in the Camp, I hereby release, waive, discharge, and hold harmless Tri Lakes Baptist Church, its pastor, employees, and volunteers from any and all liability, claims, demands, actions, and causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by the Participant or caused by the Participant during or as a result of participation in Camp activities.
Medical Release and Authorization

In the event of an emergency, I authorize Tri Lakes Baptist Church staff or volunteers to seek medical treatment for the Participant and to act according to their best judgment in any situation requiring medical attention. I agree to bear the cost of any treatment or emergency transportation.
Damage Responsbility

I accept full responsibility for any damage caused by the Participant to property, equipment, or facilities belonging to Tri Lakes Baptist Church or other participants.
Photo/Video Release (Optional)
I give permission for Tri Lakes Baptist Church to use photos or video of the Participant taken during camp activities for promotional purposes.
Signature of Parent/Guardian*

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Higher Power Soccer Camp