camp registration form
|
Release Statement
In consideration of my child’s participation in the activities of the Malone College Pioneer Soccer Camp, I declare my child medically able to participate and understand that there are inherent risks in participation. I further agree to hold free from liability all agents or volunteers of
Parent/Guardians Signature Date
Player’s First Name _____________________________________________
Player’s Last Name _____________________________________________
Address _______________________________________________________
City ______________________ ST _______ Zip ____________
Parent’s Name ___________________________________
Emergency Phone ________________________________
Grade Next Year ________________________
Fee: Make Checks payable to
$65 per child for Malone Alumni,/Faculty/Staff $95 for 1 child in family
$150 for 2 children in family
$200 for 3 children in family
$75 per player if more than 5 from same club team
(registrations must be together)
_________________________________________
Return by June 21st.
Pioneer Soccer Camp
|