WOU Youth Soccer Clinic

Wolves Youth Soccer Clinic Aug 16, 2025

2025 WOU Youth Soccer Camp Registration

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Date

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*

Photography Release

Yes
No

Please note that Western Oregon University will be taking pictures of camp participants engaging in soccer activities throughout this camp. These pictures may be used in materials to advertise these camps in the future. We kindly ask for your permission to use these photos for this purpose by agreeing to the following release.

Parental Photography Release I hereby grant permission in perpetuity to Western Oregon University to publish, republish, adapt, exhibit, reproduce, modify, make derivative works, distribute, or display my child's image and likeness in connection with the University's products and services. This permission applies to all markets and in any media or technology now known or hereafter developed. The University may exercise any of these rights itself or through any commercial or nonprofit successors, transferees, or licensees.

I waive any right to inspect or approve any University work or materials that bear my child's image or likeness.

SOCCER CAMP(S) AND WOU ACTIVITY WAIVER

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*

No
Yes

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Youth Soccer Clinic

Wolves Youth Soccer Clinic Aug 16, 2025

2025 WOU Youth Soccer Camp Registration

SOCCER CAMP(S) AND WOU ACTIVITY WAIVER

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