The Goal Club - Delaware Hayes Boys Soccer - (Delaware, OH)

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Youth Camp Registration 2017

PLAYER INFORMATION

* Player First Name:

* Player Last Name:

Grade:

Gender:

* Street:

* City:

* State:

* Zip Code:

School Name:

School Position:

Club Name:

Club Position:

SIBLING INFORMATION (First Registered Camper)

Sibling First Name:

Sibling Last Name:

Sibling Grade:

Sibling Gender:

PARENT/GUARDIAN INFORMATION

Parent First Name:

Parent Last Name:

Parent E-Mail:

Parent Home Phone:

Parent Work Phone:

Parent Cell Phone:

EMERGENCY INFORMATION

* Emergency First Name:

* Emergency Last Name:

Emergency Relation to Player:

* Emergency Phone:

WAIVER INFORMATION

I authorize the staff of Delaware Hayes Youth Soccer Camp to act according to their best judgement in any emergency requiring medical attention and waive and release the Camp from an and all liability for any injury or illness incurred while at the camp. I further consent authorizing emergency medical treatment.

I/We agree with the above waiver

PHOTO/IMAGE RELEASE

I authorize the use of my child's photograph/image during the Hayes Youth Camp and on future Youth Camp flyers/registration forms and other promotional materials.

I/we agree with the above release

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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The Goal Club - Delaware Hayes Boys Soccer

Youth Camp Registration 2017