Youth Soccer Camp Registration - Southside Baptist Church

Camp Dates: Monday, July 8th – Wednesday, July 10th from 9am-12pm.
Each program day begins at 9:00 am and ends at 12:00pm. Drop off will take place at the church’s lower building. Pick up time begins at 12:00pm.
Children will be given multiple opportunities for breaks. We will provide refreshments for hydration and breaks for restroom usage.
Snacks will be served each day during the camp.
Please be sure that your child is wearing appropriate attire (active wear) to exercise and play sports.
There are limited spots available for this camp. APPLICATIONS WILL ONLY BE ACCEPTED WITH PAYMENT.

Email Address of Registrant*

example@example.com

How many children are you registering?*

Child's Name*

First NameLast Name

Child Gender*

MaleFemale

Child's Birth Date*

MonthDayYear

Child's Age*

Last Grade Completed*

Medical or other information we may need to know about the child (including food allergies).

Child's Name*

First NameLast Name

Child Gender*

MaleFemale

Child's Birth Date*

MonthDayYear

Child's Age*

Last Grade Completed*

Medical or other information we may need to know about the child (including food allergies).

Child's Name*

First NameLast Name

Child Gender*

MaleFemale

Child's Birth Date*

MonthDayYear

Child's Age*

Last Grade Completed*

Medical or other information we may need to know about the child (including food allergies).

Child's Name*

First NameLast Name

Child Gender*

MaleFemale

Child's Birth Date*

MonthDayYear

Child's Age*

Last Grade Completed*

Medical or other information we may need to know about the child (including food allergies).

Parent/Legal Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone Number*

Area CodePhone Number

Home Phone Number

Area CodePhone Number

Emergency Contact Information

Provide the names & numbers of persons to which the child(ren) may be released to each day after camp (Please provide at least two)

Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name

Emergency Contact 1 Phone Number*

Area CodePhone Number

Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name

Emergency Contact 2 Phone Number*

Area CodePhone Number

Emergency Contact 3 (other than parent/guardian listed above)

First NameLast Name

Emergency Contact 3 Phone Number

Area CodePhone Number

Emergency Contact 4 (other than parent/guardian listed above)

First NameLast Name

Emergency Contact 4 Phone Number

Area CodePhone Number

Names of Persons to which the child (children) may be released to each day after Summer Enrichment (Please provide at least two)*

First NameLast Name

Cell Phone Number*

Area CodePhone Number

Full Name*

First NameLast Name

Cell Phone Number*

Area CodePhone Number

Full Name

First NameLast Name

Cell Phone Number

Area CodePhone Number

Full Name

First NameLast Name

Cell Phone Number

Area CodePhone Number

Are there any persons to which the child (children) may NOT be released to?*

YesNo

Who may you child (children) NOT be released to?

Include Persons' Name and Relation to the Student

I hereby authorize the volunteers of the Southside Baptist Church Youth Soccer Camp to act for me in their best judgment in any emergency requiring medical attention for my child. I hereby waive and release the program, its volunteers, and Southside Baptist Church from any and all liability for any injuries and illness incurred during the program. I will be responsible for any and all costs of medical attention and treatment. The Youth Soccer Camp and Southside Baptist Church are not responsible for any personal items that are lost, stolen or damaged. I also understand that pictures taken during the program may be used in any promotional materials. I hereby warrant that my child is in good physical condition and can participate in this program. I hereby give my permission for all my children listed above to ride the van, participate in activities, and attend Southside Baptist Church or any of the church related functions. I understand that my children will be under adult supervision. I understand that my child OR children will be obliged to abide by the code of conduct on the van and at church. I also authorize Southside Baptist personnel to act on my behalf as parent of my child while he/she is participating in church activities or on the van. I further understand that in signing this permission slip, I release and hold harmless Southside Baptist Church and all other church-related functions.By signing this permission slip, I release and hold harmless its trustees, officers, employees, interns, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached.*

YES, I give permission.NO, I do not give permission.

RULES & CODE OF CONDUCT

The goal of our Youth Soccer Camp is to build up students in our community by equipping them with an adequate and enriching recreational experience and to share the hope and love that can be experienced in Jesus Christ. Therefore, we act in accordance with our faith and our vision.

Rules

Obey leaders always. No back talking.
Participate in all activities.
Take care of the all the property of the church, players and coaches.
Do not use ANY bad language.
Always go to activities on time. Bathroom breaks are between classes.
No fighting or instigating fights. The church needs to be a place of peace.
Please dress appropriately for exercising and playing sports

General Consequences for Rule-Breaking

First Occurrence: Student will receive a verbal warning from the leader or assisting adult in the group.
Second Occurrence: Student will be removed from group by an assisting adult. A private discussion should resolve the problem and the student may return to activity.
Third Occurrence: The student will be removed from group by an assisting adult. The student’s parent will be notified of their behavior as quickly as possible. Resolution of the issue will be affected by the student, parents and leader(s) prior to the student returning to activities.
Fourth Occurrence: Repetitive breaking of the offense will result in disciplinary action (ranging from performing service duties to student suspension) for the student. If the student refuses to perform the task(s) asked of him or her, a suspension will be served immediately. No refunds will be issued regardless of participation.

I have read and understand the Rules and Code of Conduct.*

YES, I have read and understand the rules and code of conduct.NO, I have NOT read and DO NOT understand the rules and code of conduct.

The cost of our Youth Soccer Camp is $10 per child. Payment must be made before your child(ren) can participate in the program. Payment can be made at the Southside Baptist Church administrative office by exact cash, check (addressed to Southside Baptist Church), or money order. Payment Deadline: Monday, July 8th, 2019.

How will you be paying for the Soccer Camp Registration?*

Exact CashCheckMoney Order

Registration Application

First Child

Second Child

Third Child

Fourth Child

Parent/Guardian & Emergency Contact Information

Child Pick-Up Information

Camp Release Information

Payment Information