Lady Wolverines Soccer Camp
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Participant name *
Parent/Guardian Name *
Valid Parent/Guardian cellphone *
We will contact you for information and/or emergencies.

I, (name of parent/guardian below), certify that my child is in good health and does not have a history of injury or illness that could endanger the safe participation in this soccer camp. I further understand the inherent risk of participating in athletic activities. I authorize the coaching staff to act on my behalf and use their best judgement in case of an emergency.  I hereby waive any and all liability, including negligence, medical claims, causes of action, and rights of entitlement, suits or damages against and release PSJA Memorial School and Staff, the Athletic Department, or any of its employees, contracted agents or representatives, as a result of or in conjunction with athletic participation in the soccer camp. I further understand and acknowledge that PSJA Memorial School and Staff is under no obligation to provide financial support for any injuries and that any bills for medical services required as a result of my child’s participation in the soccer are the sole responsibility of the parent/guardian. I have read the above statements and I am willing to voluntarily assume full responsibility for the risks while participating in the soccer camp. Electronic Signature (Parent/Guardian name) required.

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