2021 Eclipse Summer Camp Registration

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Email *

Player Name *

Date of Birth (include year) *

YYYY

Gender *

Female

Male

Any additional email addresses

Street Address *

City *

Phone Number(s) *include any additional numbers to call in case of emergency *

Are there any allergies, illnesses, or injuries we should be aware of?

I, as the listed parent/guardian of the player listed on this form, give permission for my child, a minor, to participate in all activities for the East Bay Eclipse Soccer Club. I, on the behalf of myself and my player listed on this form, release and indemnify East Bay Eclipse Soccer Club, its employees and other personnel, and all owners of fields used by the East Bay Eclipse Soccer Club, as well as their employees and other personnel, against any claims, damages, or liabilities brought on as a result of the player’s participation in the East Bay Eclipse Soccer Club. I also grant my authorization and consent for East Bay Eclipse Soccer Club personnel to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the personnel of East Bay Eclipse Soccer Club to summon any and all professional emergency personnel to attend to, transport, and treat the participant. *

A copy of your responses will be emailed to the address you provided.

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