City, STATE Zip Code*
Parent/Guardian Phone Number*
Emergency Phone Number*
Special Medical Conditions
Grade (Fall 2018)*
YS (Youth Small)
YM (Youth Medium)
YL (Youth Large)
AM (Adult Medium)
AL (Adult Large)
(You will be required to sign a permission form prior to your child/ren participating in the 2018 Soccer Camp.) By submitting this electronic registration form I agree to the following:
Camp fee of $20.00 is due on the first day of Soccer Camp (June 11, 2018). I acknowledge that there are dangers and risks of injury inherent in sports activities, but still allow my child/ren to participate in said activities.
THEREFORE, the undersigned, for and in consideration of the opportunity to participate in the Living Water Lutheran 2018 Soccer Camp and for other good and valuable consideration, does hereby accept full responsibility for liability and cost of treatment of injury to the above-registered person. The undersigned does hereby release the teachers/coaches/assistants and Living Water Lutheran Church from all liability resulting from negligence and agrees to hold them harmless for any injuries and/or damages his/her child may sustain arising out of the activities inherent in a soccer camp. The undersigned further declares and represents that no promise, inducement or agreement not herein expressed has been made to the undersigned, and that this release contains the entire agreement between the parties hereto, and that the terms of this release are contractual in nature and not a mere recital.*
Yes, I agree to the Permission Statement
REQUIRED SIGNATURE: Please indicate whether you will be present on the first day of Soccer Camp to sign the Permission Form. If you are not able to be present, we will mail you a form for your signature. The Permission Form MUST be signed and returned prior to your child/ren participating in Soccer Camp.*
Yes, I will be present to sign form.
No, please mail the form to me.