Camp Registration Form

Which Program(s) Will You Be Signing Up For?

Playschool Monday (3-4 yr olds)Playschool Tuesday (2-3 yr olds)Playschool Thursday - bilingual (2-3 yr olds)After School Care

Childs Information

Childs Name

First NameLast Name

Birth Date

MonthDayYear

Age

Sex

malefemalerather not say

Parent/Guardian Information

Name

First NameLast Name

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*

If Signing Up For After School, What School Does Your Child Attend?

Informed Consent and Acknowledgement

I hereby provide my consent for my child's participation in all activities organized by the camp during the chosen session. By accepting my child's participation, I acknowledge and accept all the potential risks and hazards associated with these activities. I release, exempt, and indemnify the soccer camp and all its officials, representatives, and agents from any responsibility for injuries that may occur to my child during their travel to, engagement in, or return from the camp sessions.

If my child sustains an injury, I waive any claims against the camp, including its coaches, affiliates, fellow participants, supporting organizations, advertisers, and, if applicable, the owners and landlords of the premises where the event is held. Engaging in sports activities, including soccer, inherently carries a risk of injury, which may include but is not limited to fractures, paralysis, or even fatality.

Signature*

Medical Release and Authorization

As the legal guardian of the youth athlete listed, I hereby grant permission for qualified and licensed medical professionals to diagnose and administer treatment in the event of a medical emergency. This authorization is applicable when, in the medical professional's judgment, immediate attention is necessary to prevent further harm to the minor child's life, physical appearance, physical functionality, or to alleviate undue pain, suffering, or discomfort should there be a delay in treatment.

I hereby give consent to the attending physician to undertake any necessary medical or minor surgical procedures, conduct X-ray examinations, and administer immunizations to the youth athlete named. In cases of a serious illness, the requirement for major surgery, or significant accidental injury, I am aware that the attending physician will make every reasonable effort to contact me as swiftly as possible before proceeding with treatment. This authorization is granted after a reasonable attempt has been made to reach me.

I also authorize the affiliated individuals, including Directors, Coaches, and Team Parents, to provide essential emergency treatment before the child is admitted to a medical facility.

This consent is valid during the dates and for the duration of the registered season. I willingly provide this authorization to ensure prompt medical treatment under emergency circumstances, safeguarding the life and well-being of the named minor child when I am not present.

Signature*

Photo Authorization Form I hereby authorize The Playhouse, its staff, and representatives to take photographs and/or video recordings of my child during program activities. I understand that these images may be used for the following purposes: Social media (e.g., Facebook, Instagram, TikTok) Classroom documentation and displays I acknowledge that My child’s name or personal details will not be shared publicly without additional consent. This authorization is voluntary and may be revoked in writing at any time.

YESNO

Initials*

Shirt Size

shirts are kids sizes

Your spot is not held until payment is received and that an invoice will be sent to me after completing this form

I Understand

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