2019 Parkway Central Summer Youth Camp
This is the registration for the 2019 Parkway Central Summer Youth Camp held at Parkway Central the week of June 17-21 from 2:00-4:30 pm. Camp costs are $100 per player and each camper receives a camp t-shirt and extra take home gift. Please complete this form for each camper.
Camper First Name *
Your answer
Last Name *
Your answer
Gender *
T-Shirt Size
Grade Next Fall *
What grad will the player be in fall 2017.
School Next Fall *
Please list the school the player will attend in the fall of 2017
Your answer
Date of Birth
MM
/
DD
/
YYYY
Special
check all that apply. You may leave this blank
Experience
list soccer experience including camps, cyc, club. NO EXPERIENCE NECESSARY. You may leave this blank.
Your answer
Waiver *
By checking the box, you hereby authorize the directors of the Parkway Central Soccer Camp to act for you according to their best judgement in an emergency. You know of no mental or physical problems which might affect your child's ability to safely participate in this camp. You will be responsible for any medical or other charges in connection with your child's attendance at camp. You agree that your child must abide by the rules and regulations of this camp. You also authorize the hospital/physician/dentist to perform necessary procedures.
Medical Concerns and Preferred Hospital
What medical concerns should we know about? By leaving this blank, you allow us to arrange for the quickest hospital.
Your answer
Guardian 1 Full Name *
Your answer
Guardian 1 email *
Your answer
Guardian 1 Phone *
Please give us the best phone number for us to contact you.
Your answer
Second Contact Name and Relationship
Your answer
Second Contact email
Your answer
Second Contact Phone
Your answer
Informed
How did you find out about our youth summer camp?
Your answer
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