Cross of Life Soccer Camp Registration Form 2019

Soccer Camp will be from the dates of July 8-12, 2019

Drop off 1:00pm and Pick up 4:00pm

Payment is required at the time of submission of this form by major credit card or PayPal.

Parent/Guardian Information

Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	Province
Postal Code	Country

E-mail *

Home Number

Work Number

Mobile Number

Preferred Number to Contact *

Church Home

Church you currently attend (if any)

How did you FIRST find out about this camp? *

Email Flyer Friend Facebook Newsletter Google Search Mississauga Kids Ad Previous Camper

BBQ on July 12th - # of attendees *

Player Information

1st Child Name *

First Name Last Name

Gender *

Male Female

Age *

Birth Date

Month Day Year

Shirt Size *

2nd Child Name

First Name Last Name

Gender

Male Female

Age

Birth Date

Month Day Year

Shirt Size

3rd Child Name

First Name Last Name

Gender

Male Female

Age

Birth Date

Month Day Year

Shirt Size

4th Child Name

First Name Last Name

Gender

Male Female

Age

Birth Date

Month Day Year

Shirt Size

Emergency Information

Do any of these children have any allergies, chronic illness, or medical conditions? If yes, please describe.

(Please include the name of the child)

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Alt. Phone Number

Alt Phone Number

THE PARTICIPANT IS RESPONSIBLE FOR HIS OR HER OWN MEDICAL COVERAGE

NOTICE OF WARNING: There is a potential risk in training and participating in any sport, and we have tried to create a safe environment. The coaches have established rules for participation, and proper conduct on or about the playing field must be followed.

AGREEMENT: I have read and understand the policies and the risk involved. I hereby agree that my children will follow all rules for good order and safety during this camp. I agree and understand that neither Cross of Life Lutheran Church, nor any of the volunteers involved are liable for any injuries received while participating or playing in the activity for which I am registering herein, or for the loss or damage to equipment. I agree that I shall make no claim and bring no action, suit, or proceeding for any and all damages, losses, liabilities, or costs in any manner suffered or incurred as a result of my participating in the activity for which I am registering herein, and I hereby release Cross of Life Lutheran Church and its officers, directors, and pastor, the City of Mississauga, and the Region of Peel District School Board from any and all damages, liabilities, or costs in this regard. I also agree that by signing this form, the email address I have given can be used by Cross of Life to inform me of future church programs. I may unsubscribe at any time.

PHOTOGRAPHS AND VIDEO: I understand that any pictures or video footage taken of my child by church personnel may be used in future promotion material for the church soccer camp, printed or online.

CANCELLATION POLICY: A fee of $15 applies to all cancellations. If cancellation is received 10 days prior to start of camp, a refund (minus the cancellation fee) will be made. No refunds will be made for cancellations after July 3. No refunds will be given for cancellations due to inclement weather. CoL is not responsible for lost items belonging to participants.

WEATHER POLICY: We generally will play through light rain, and ask participants to bring proper clothing and gear. If weather forecast makes it impossible to even begin camp, we will try to have announcements posted on our web site. If weather becomes severe after we begin a day’s session, (thunder, lightning, hail), we will take the kids over to the large shelter at Lisgar Park across from Lisgar Middle School’s parking lot. Camp personnel will wait with children there as long as necessary. Parents can pick their children up during this time if possible. If the severe weather subsides, the remaining participants will go back onto the fields and continue the camp as scheduled.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE AS EQUALLY BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Enter the message as it's shown *

Payment

Registration (per child) $ 85.00 CAD

Select # of children

Total $ 0.00 CAD

Payment Method

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please only click the SUBMIT button once or you may put through multiple transactions. Thank you!