2010 Frederick County Camp Registration

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Player's first name*
Player's last name*
Street Address*
City
Zip code*
Day time phone*
Cell phone
Email*
Confirm Email*
Age as of First Day of Camp*
Gender*
Size T-shirt*
Club team*
Division Club Team*
Name Coach*
How did you hear about us?*
Medical information we should be aware of*
Parent / Guardian name*
By accepting, I, the parent or legal guardian of the player listed above, ask that he/she be admitted to participate in the Dutch Soccer School Camp (the "Program") held by Dutch Soccer School. I understand the risks and hazards associated with my child's participation in the Program and certify that my child is in good health and give my permission for his/her participation in the program. I authorize all emergency and medical treatment which may be needed in the event of any injury. I also understand that primary insurance coverage is my own responsibility. In consideration of such admission, I do hereby agree to release, discharge, and hold harmless Dutch Soccer School and each of their coaches,officers, agents, and employees of and from all causes, liabilities, damages, claims, or demands whatsoever on account of any injury or accident involving the said minor arising out of the minor's attendance at the program or in the course of competition and/or activities held in connection with the Program.*
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