2019 SEBC High Power Soccer Camp
Registration Cost: $30 per child
Event Date: July 29-August 2, 5:30 P.M. to 8:00 P.M.
Event Address: 506 Carrollton Dr, Frederick, Maryland 21701
Contact us at (301) 662-4780 or jennifer@southendbaptist.org
Child's First Name *
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Child's Last Name *
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Parent/Guardian's First Name *
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Parent/Guardian's Last Name *
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Street Address *
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City *
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State *
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Zip Code *
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Home Phone *
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Cell Phone
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Email *
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Medical or other information we need to know, including food allergies. Type "None" if there are no issues. *
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Child's Date of Birth *
Child's Last Grade Completed *
Gender *
Emergency Contact Name *
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Emergency Contact Phone Number *
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Person(s) other than Parent/Guardian authorized to pick up child
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Child's T-Shirt Size *

1. By registering for this program, I verify that my child's immunizations are up to date.
2. That there are inherent risks and dangers associated with soccer programs and therefore, I hold South End Baptist Church (SEBC) and SEBC volunteers harmless from all claims of injury, damage, or loss which may result from my child's participation in the High Power Soccer Camp.
3. That I must be aware of the hazards associated with each activity, such as use of equipment, slips and falls, personal level of fitness, training, and various athletic injuries related to this activity.
4. That the possible consequences of participating in these activities include the possibility of serious injury.


1. To obey the rules and regulations for each activity and to follow the directions of the staff.
2. To inform a staff member of any dangerous or potentially hazardous situation that I may observe.
3. That if I do not understand how an activity is performed or how a piece of equipment is to be used, I will ask a staff member prior to beginning that activity.
4. To inform a staff member if I have any problems meeting the physical requirements necessary for participation in any activities.
5. To allow South End Baptist Church to take and utilize photos, slides, and video images of the above registered individual for the purpose of promotion and publicizing the High Power Soccer camp.

I have read and understood the Agreement. *
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