Laurelwood Baptist Church of Vancouver WA

Child's Name*

First Last

Birthdate*

Age*

Grade In Fall 2023*

Please enter a number from 1 to 7.

Gender*

Male
Female

Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian*

First Last

Cell Phone*

Email*

Enter Email Confirm Email

Emergency Contact (other than parent)*

First Last

Emergency Contact Phone*

Child's Doctor*

Doctor's Phone*

Allergies/Medical Conditions

I'd like to be placed on the same team with my friend(s) listed below.

T-Shirt Size*

Youth M
Youth L
Adult S
Adult M

Payment Amount*

$40
$30 'cause I'm bringing a friend
$30 'cause I'm the lucky friend

Payments can be made online, cash, or a check made out to Laurelwood Baptist Church.

Friend's Name (If you selected "'cause I'm the lucky friend!" above)

Parental Consent*

I agree to the Medical Consent & Release of Liability below.

My child listed above has my permission to participate in the Laurelwood Soccer Camp. In the event of an emergency and I cannot be reached, I grant permission for emergency medical treatment to be given to my child. I assume all responsibility for all medical bills. I also give my permission for my child to be photographed and for photographs to be used by Laurelwood for publicity purposes. I have included information in the Registration & Player Information Form regarding allergies or other medical conditions about my child which the staff should be aware of.

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Phone

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Soccer Camp 2023

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