Mental Health with Marty Community Soccer Camp
September 26, 2026 Ages: 5-17 Location: Central City Park Fields 8380 Cypress Ave Fontana, CA 92335
Parent's/Guardian Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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First and Last Name of Child #1
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Date of Birth of Child (MM/DD/YY) #1
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First and Last Name of Child #2
Date of Birth of Child (MM/DD/YY) #2
First and Last Name of Child #3
Date of Birth of Child (MM/DD/YY) #3
First and Last Name of Child #4
Date of Birth of Child (MM/DD/YY) #4
Emergency Contact Name
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Emergency Contact Phone Number
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Does your child have allergies?
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Yes
No
If so, what are the allergies?
Does your child/children have any medical conditions?
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Yes
No
If so, what are the medical conditions that we need to watch out for?
I consent to photo/video being taken of my child/children.
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Yes
No
I acknowledge the camp guidelines and participation requirements
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Yes
No
Submit
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