Child's Name *
Child's Name
Parent/Gaurdian's Name *
Parent/Gaurdian's Name
Primary Phone *
Primary Phone
Address *
Address
Child's Birth Date *
Child's Birth Date
Person responsible for pick up child at the end of camp each day: *
Person responsible for pick up child at the end of camp each day:
Phone *
Phone
has my permission to participate in the Midway Soccer camp at Midway Baptist Church. In case of emergency (when the parent or guardian cannot be reach), I authorize any of the adults named below to secure medical treatment necessary for the welfare of my child. Depending on the medical need and the inability to contact the names listed below, leader of the above named activity have my permission to seek appropriate treatment for child or youth listed above.
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact 1 Phone *
Emergency Contact 1 Phone
Emergency Contact 2 *
Emergency Contact 2
Emergency Contact 2 Phone *
Emergency Contact 2 Phone
Emergency Contact 3
Emergency Contact 3
Emergency Contact 3 Phone
Emergency Contact 3 Phone