Lady Dragons Soccer Camp
COMPLETE ONE REGISTRATION FORM FOR EACH CAMPER
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Age
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Date of Birth
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Current Grade
Camper's School
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Camper's T-Shirt Size
Parent Name
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Parent Contact Phone #
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Parent Email
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Additional Emergency Name and Phone #
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Name of Lady Dragon Soccer Player who referred you to the 2017 Summer Camp
*Lady Dragon Soccer Player will get a portion of the registration fee to cover player fees for the 2017 Fall Season.
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Medical Conditions or medications staff needs to be aware of during the camp session.
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I, the parent / guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Lady Dragons Soccer Camp, and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer. I hereby release, discharge and/or otherwise indemnify the Lady Dragons Soccer Camp, coaches, players, and sponsors, West Clark Community Schools against any claims on behalf of the registrants as a result of the registrant’s participation in the programs.
By typing your Full Legal Name you are agreeing to the above statement. No registrant may participate without consent.
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I authorize use of player photos on the school's website or in newspapers.
I will submit payment of $35 (K-4) or $45 (5-7)per registrant in full by May 31, 2017 to Lady Dragons Soccer Camp, SCHS, 557 Renz Ave, Sellersburg, IN 47172
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Please list names of siblings attending the Lady Dragons Soccer Camp
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