Form Soccer Clinic Registration for Laurelwood's Soccer Clinic Child's Name* First Last Birthdate* Date Format: MM slash DD slash YYYY Age*Grade In Fall 2021*Please enter a number from 1 to 6.Gender*MaleFemaleAddress* 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 ConditionsI'd like to be placed on the same team with my friend(s) listed below.T-Shirt Size*Youth MYouth LAdult SAdult MPayment Amount*$40$30 'cause I'm bringing a friend$30 'cause I'm the lucky friendPayments can be made online, cash, or a check made out to Laurelwood Baptist Church.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.