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First Name: *

Last Name: *

Birthdate: *

/ / mm/dd/yyyy

Gender: *

Shirt Size: *

Experience: *

Team Name:

Club Affiliation: *

Referred From:

Medical Concerns:

Available Programs: *

Policy Statement: *

Soccer is at times a physical, contact sport. Personal medical insurance is required. I herby give permission for my child to be immediately treated for any injury or illness during the camp. I herby waive any liability or accountability to Soccer Precision, LLC for personal injury to my child or loss or damage to their property. I give Soccer Precision, LLC permission to use my child's picture or likeness in promotion of Soccer Precision camps in printed or electronic media or other forms of advertisement. I renounce any and all claims upon Soccer Precision, LLC for reimbursement for use of this material.

I have read and accept the Policy Statement above.

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