Soccer Camp Child Registration 2016
June 20-23, 2016
Child's First Name *
Your answer
Last Name *
Your answer
Parent Name *
Your answer
Email Address *
Your answer
State
Your answer
Address *
Line 1
Your answer
Line 2
Your answer
City
Your answer
Zip Code
Your answer
Phone Number *
Your answer
Child's Age Group *
Allergies, Medical, & Special Needs
Your answer
Emergency Contact Phone Number *
Your answer
Authorized Pick-Up #1 *
Your answer
Authorized Pick-Up #2
Your answer
Do you or your child attend church? *
If you answered yes to attending another church, what church do you attend?
Optional
Your answer
Have you read and do you agree with the consent agreement Below? *
CONSENT & LIABILITY AGREEMENT: In consideration of CrossPointe Church allowing the above child to participate in the Soccer Camp activities. We (I), do hereby release, forever discharge and agree to hold CrossPointe Church, its directors, employees, volunteers and agents (collectively herein the "Church") from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above child while involved in Kids Camp. Furthermore, we (I) [and on behalf of our (my) minor child(s)] hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in activities involved therein.
Do you agree with the Photography statement below?
I give permission for CrossPointe Church to photograph, video and/or record my child with full understanding and agreement that such still photographs, videotapes and/or sound recordings separately or in combination can be used in publications/broadcasts deemed necessary by the said organization for publicity/promotion of CrossPointe Church or for crafts to be sent home with child. I also hereby release all rights, title and interest of said materials to the ownership of CrossPointe Church.
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