THE WHARTON SOCCER CLUB
SUMMER SOCCER CAMP
REGISTRATION FORM
JULY 21-25, 2008
9:00am-12:00 Noon
Fees: $95 for first camper, $75 for each additional camper from a family.
Please fill out a separate form for each camper.
Camper’s Name: First_________________________ Last _______________________________
Birth Date: _____ /____/______
Address:________________________________________________________________
Street
Phone: ______ -_________
Town State Zip Code
Camper’s Preferred Position(s): _____________________________
After your registration, a medical information form will be sent for your completion.
I/We, the parents of the above named player, do hereby give my/our approval for the said named player to participate in all soccer activities associated with The Summer Soccer Camp of the Wharton Soccer Club, Inc. I/We assume all risks and hazards incidental to such participation, including transportation to and from the activities. I/We do hereby waive, release and absolve, indemnify and agree to hold harmless The Wharton Soccer Club Inc., its members, supervisors and participants, from claims arising out of injury to my/our player, except to the extent and in the amount covered by accident or liability insurance. As a parent and/or guardian of above named player, a minor, I hereby authorize the treatment by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger my child’s life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me.
Parent(s) Signature: ________________________________________ Date:_____/______/__________
DO NOT COMPLETE AREA BELOW - TO BE COMPLETED BY WSC OFFICIAL ONLY.
WSC Official: ____________________ Date:_____/______/_________
Registration Fee: $_________________ Cash _____ Check #_______________