Oberlin Soccer Camps Youth Day Camp Registration

Participant Information

Full Name *

Player's Birth Date * +

Grade Entering in Fall: *

Please indicate your payment method: *

PayPal via oberlinsoccercamps.com

Check or Cash sent to: Oberlin Soccer Camps, 260 Forest street 44074

Venmo: @Blake-New-1

Household / Adult Primary Contact

Relationship to Participants: *

Parent

Guardian

Coach

Other Other

First Name *

Last Name *

PARENT’S APPROVAL AND MEDICAL RELEASE Recognizing the possibility of physical injury associated with soccer and in consideration for the Oberlin Soccer Camps and its affiliates accepting the registrant for its soccer programs and activities (the "Programs"), I hereby release, discharge and/or otherwise indemnify Oberlin Soccer Camps, Oberlin College, The City of Oberlin, and all affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs against any claim by or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. My son/daughter has received a physical examination by a physician and had been found physically capable of participating in the Programs. I hereby give my consent to have an athletic trainer and /or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of such assistance and/or treatment. * 🛈

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Address 1 *

Address 2

City *

State *

Zip *

Phone

Email Address *