Kickin 4 Kidz Youth Soccer Camp
REGISTRATION FORM
June 19, 20, and 21
LEFCON Auxiliary Field, Doc's Way, Mars PA
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Email *
Parent First and Last Name *
Parent Phone Number *
Parent Address *
Camp Participant Name *
Camp Participant Age and Grade *
Emergency Contact Information (Name and Phone Number) *
Applicable Pick-up / Drop-off Information
Other Details (Please list anything that we need to know, including allergies, medical limitations, etc.) *
Injury Release Waiver and Acknowledgment of Risk
I understand and agree that participating in the Soccer Camp being held on June 21, 22, and 23, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during these activities.  I also exempt, release, and indemnify Inspired Hearts and Hands, Mars Soccer, its coaches, agents, volunteers, assistants, employees, faculty members, and/or students from all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any camp activities conducted by Inspired Hearts and Hands and the Mars Soccer Team. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Inspired Hearts and Hands, Mars Soccer, and its coaches, agents, volunteers, assistants, employees, guests, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights.  I have read, understood, and agree to be bound by the above statement.
Injury Release Waiver Consent (REGISTRATION IS INCOMPLETE WITHOUT AGREEMENT) *
Required
Photography Release Waiver
Permission is granted for Inspired Hearts and Hands to use photographs of my camp participant for publicity and related media purposes.
Photo Release Consent:  (REGISTRATION IS INCOMPLETE WITHOUT AGREEMENT) *
Required
COVID-19 Waiver
I knowingly and willingly consent for my child to participate in practice, games, camps, clinics, or activities.  I/my child have not come in contact with any person who has tested positive for COVID-19 in the past 10 days (when applicable).  I verify that I/my child have not traveled outside the continental U.S. in the past 14 days (when applicable).  I/my child will follow all safety procedure put in place by PA Department of Health.  I/my child have not had a fever in the past 48 hours (when applicable).  I will not bring my child to dance practice, rehearsals, games, camps, clinics, performances, or activities if they are sick and/or have had a fever in the past 48 hours (when applicable). I have read, understood, and agree to be bound by the above statement.
COVID 19 Waiver Consent:  (REGISTRATION IS INCOMPLETE WITHOUT AGREEMENT) *
Required
A copy of your responses will be emailed to the address you provided.
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