SOCCER & STEAM
Summer Camp | 2022
REGISTRATION & WAIVER FORM
NAME OF PLAYER
DATE OF BIRTH
PARENT/GUARDIAN
PHONE
EMAIL
DOES YOUR CHILD HAVE ANY MEDICAL PROBLEMS THAT COACHES, OR STAFF SHOULD BE AWARE OF?
No
Yes
IF YES, PLEASE EXPLAIN
MEDICAL INSURANCE COMPANY & POLICY NUMBER
PLEASE REVIEW THE TERMS AND CONDITIONS: On behalf of my child, I certify that my child is in normal health and capable of participation in this program. I further understand that participation in this program involves risk and possible injury and represent to Tiny Feet Soccer that my child has medical health insurance to cover any injuries sustained as a result of participation in this program. It is agreed that Tiny Feet Soccer directors and/or staff assume no liability for injuries sustained as a result of participation in the program. I authorize the Tiny Feet Soccer staff to secure emergency medical treatment should my child require it. Further, I grant full permission for the free use of my name and/or any photographs, videotapes. Motion picture recordings or any other record of this event for legitimate purposes.
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