Clone of Soccer Camp Registration Form

Camp Registration Form

Fill out the form below to register
Player 1 Name*

First NameLast Name
Player 1 Birth Date*

MonthDayYear
Would you like to add another player?

YesNo
Player 2 Name

First NameLast Name
Player 2 Birth Date

MonthDayYear
Would you like to add another player?

YesNo
Player 3 Name

First NameLast Name
Player 3 Birth Date

MonthDayYear
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any medical or dietary restrictions they have
How did you hear about this camp?
Have you previously attended this camp?

Family Information
Parent/Guardian's Name*

First NameLast Name
Contact Phone Number*
E-mail Address*
example@example.com
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship to Player*
Primary Care Physician*
Primary Care Physician Phone Number*

By signing below, the undersigned parent or legal guardian of the Participant acknowledges that soccer involves inherent risks, including the risk of injury, and voluntarily assumes all such risks associated with the Participant’s participation in this soccer camp. The undersigned agrees to release, indemnify, and hold harmless Cincinnati Soccer Camp, its employees, agents, and volunteers from any and all claims, injuries, damages, or liabilities arising from the Participant's involvement in camp activities, including transportation to and from the event. The undersigned further authorizes camp staff to seek emergency medical treatment for the Participant if necessary and understands that they are responsible for any related costs. Additionally, the undersigned grants permission for the Participant’s image to be used for promotional purposes by the Camp. This waiver shall be binding upon the undersigned and the Participant’s heirs and representatives.
In the event of an emergency, I give permission for my child to receive medical treatment as deemed necessary.*

YesNo
Do you consent to us taking photos of your child during the camp?*

YesNo
I acknowledge that the participant will follow all camp rules and understand that failure to do so may result in dismissal from the camp without a refund*

YesNo
I understand that the camp registration fee is non-refundable unless canceled by the camp.*

YesNo
By signing below, I confirm that the information provided is accurate and that I have read and agree to the terms of the waiver, camp policies, and other agreements listed above*

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Click the link below to pay for the camp:
The cost is $40 per camper which will go towards supporting the nonprofit Soccer Without Borders

When paying, please leave a note with your child's name and the phrase "Soccer Camp"

Venmo Link To Pay

If you would like to pay an alternative way or if you have any questions, email Julie Belfor at belforjulie@gmail.com.
Additional Notes/Questions
Should be Empty:

Camp Registration Form

Family Information

Emergency Contact Information

Click the link below to pay for the camp: