Soccer Summer Camp Registration | North UMC

Registration for North UMC's Soccer Outdoor Summer Camp

Please complete the form to register your child.

Student First Name

Student Last Name

Student Street Address

City

State

Postal / Zip code

Date of Birth

Current School

Parent 1 Name

Parent 1 Phone Number

Parent 1 Email

Parent 2 Name

Parent 2 Phone Number

Parent 2 Email

List any medical conditions or prohibitions player has

Person to notify in case of emergency:

Emergency Phone #

Doctor to notify in case of emergency:

Doctor's Phone

Medical Insurance Company

Policy Holder's Name

Policy Holder's Number

I, or the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of North United Methodist Church (NUMC), its affiliated organization and sponsors. Recognizing the possibility of physical injury and in consideration for NUMC accepting the registrant for its STEM-VBS Summer Camp and activities (the “Program”), I hereby release, discharge and/or otherwise indemnify NUMC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the programs and/or being transported to or from the same, which transportation I hereby authorize .

Your Signature

Select a date

Thanks for registering your child!

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