Washington Township SC Summer Camp
Please fill out the following information to register for camp.
Parent / Guardian *
Your answer
Email *
Your answer
Cell # *
Your answer
Player Name *
Your answer
D.O.B *
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/
DD
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YYYY
Current Club *
Your answer
Team Name & Age Group *
Your answer
I am registering for the following camp; *
Required
As parent/guardian of the above player, I certify that he/she is in excellent health and has no physical, mental or emotional problems that are likely to prevent participation in strenuous, physical play within the soccer program. I agree to hold harmless Philadelphia Fury, its agents, coaches, and employees and hereby release them from any liability on account of injuries sustained by the player while participating in the soccer program activities. I give permission for the player to be medically treated for illness occurring, or injury sustained, during such participation. I certify that the player is covered by medical insurance which will reimburse Philadelphia Fury for expenses incurred by them, their agents, coaches and employees on account of medical insurance ordered at their discretion and also to indemnify them for any expenses not reimbursed by such insurance. I give consent for the player to be photographed, videotaped and/or filmed while participating in the soccer program activities and for the resulting photos to be used by Philadelphia Fury for educational and promotional purposes. Philadelphia Fury are not responsible for any cancellations due to inclement weather. *
Required
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