WOU Youth Soccer Clinic - Accounting & Business Services

Wolves Youth Soccer Clinic

Child's Name*

First Last

Age*

Parent's Name*

First Last

School

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

Email*

Coaches will be in contact with your through email.

Emergency Contact Name*

Emergency Contact Phone*

Insurance Company*

Insurance Policy Number*

I hereby register my child for the WOU Soccer Camp(s) and authorize the staff to direct my child in participation of the camp activities.
I know of no mental or physical problems that may affect my child’s ability to safely participate in this camp. I acknowledge that I am responsible for any and all medical or other charges incurred in connection with my child’s attendance at the WOU Soccer Camp(s).
In consideration for my child’s participation in the WOU Soccer Camp(s), I hereby release and hold harmless the WOU Soccer team, coaches, Western Oregon University and its employees, agents and assignees from any and all liability that may arise out of my child’s participation in the camp including transportation to and from, or in connection with said school in any vehicle operated on behalf of the WOU Soccer Camp staff and Western Oregon University.
The WOU Soccer team or employees thereof are authorized to seek medical treatment as necessary in the event of injury, accident or illness to my child.

I have read and accept the SOCCER CAMP(S) AND WOU ACTIVITY WAIVER*