PEAK FORM SOCCER

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Camp Registration
Player's full name:
 * required
Age:
 * required
Grade:
 * required
T-Shirt Size:
 * required

Street Address:

 * required

City:

 * required

State:

 * required

Zip:

 * required

Parent's full name:

 * required

Email:

 * required

Home Phone:

 * required

Cell Phone:

 * required

Session:

Emergency Contact Name:

 * required

Emergency Contact Phone:

 * required

Existing Physicial Conditions:

Insurance Company:

 * required

Policy #:

 * required
 

The parent or guardian understands that the camper will be engaging in physical activity during the program which contains an inherent riskof physical injury, and the parent or guardian assumes the risk and releases PEAK FORM SOCCER and ROCKDALE YOUTH SOCCER ASSOCIATION, it's directors and employees from any and all liability for personal injury arising out of the camper's participation in the camp program. I hereby grant permission for my child to attend the PEAK FORM SOCCER soccer camp and to be treated by a licensed physician or member of the athletic training staff in the event of any injury, illness or mishap.

I Agree
 

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Peak Form Soccer * 1780 Old Salem Rd * Conyers * GA * 30013

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