Santos Soccer Camp 2015

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    Child #1

    This is a required question
    This is a required question
    Must be a number
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    This is a required question
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    This is a required question

    Child #2

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    This is a required question
    Must be a number
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    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Child #3

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    This is a required question
    Must be a number
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    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Child #4

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    This is a required question
    Must be a number
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    This is a required question
    This is a required question
    This is a required question
    This is a required question

    Parent/Guardian Information

    Please include both first and last names.
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    Please include both first and last names.
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    This is a required question
    Incorrect format or missing information.
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    Must be a valid email address
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    Incorrect phone number format.
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    Incorrect phone number format.
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    This is a required question

    Other Contact Information

    The camp director will make every effort to reach the emergency contacts given on this form. However, in case of a medical emergency, I hereby give my permission to the physician selected the camp director to secure proper treatment and/or hospitalization for my child/children.
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    Incorrect phone number format.
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    This is a required question
    Incorrect phone number format
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    This is a required question
    Incorrect phone number format.
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    E-Signature

    My initials, given below, constitute an electronic signature to this document, including the following terms: Recognizing the possibility of physical injury associated with soccer, I hereby release, discharge, and/or otherwise indemnify the Santos Soccer Club and Grace Presbyterian Church, it’s affiliates and facilities utilized for the “programs” against any claim by or on behalf of the registrant as a result of the registrant’s participation in the “programs” and/or being transported to or from the same, which transportation I hereby authorize. I hereby give consent to have an athletic trainer, emergency medical technician and/or doctor of medicine or dentistry provide my son/daughter with medical assistance, treatment and/or transport and agree to be responsible financially for the reasonable cost of such assistance and/or treatment. *Photographic Consent*: I understand that, when participating in camp activities, my child may be photographed for print, video, or electronic imaging. I understand these images may be used for future promotional materials for the camp and Grace Presbyterian Church and give permission for them to be used for such without royalties or other remuneration.
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