Participant information:


First name*
Last Name*
Home Phone*
Second Phone
Parent Name*
Participant Age*
Participant Birthdate* Calendar
T-Shirt Size
Get Ready For Fall Soccer!

Ages 8-12, July 20 - 22

6:00pm-8:00pm Daily- $75  
Medical Information & Consent-*

Alternate who can be notified in emergency

Medical Insurer

*include policy#

Dentist's Phone
Any medical concerns or limitations
I agree with the terms below*

*Yes is required to register

AGREEMENT: I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Arrowhead Youth Soccer Association (AYSA) and the Boot Room Soccer Camp. I hereby release, and/or otherwise indemnify the AYSA, Boot Room Soccer, and its affiliated organizations, their employees and contractors, and the owners of fields and facilities utilized for the camp, against any claim by or on behalf of the registrant as a result of their participation in the camp. 
REFUNDS: Refunds will only be granted if requested more than 3 weeks prior to the first session date.
MEDICAL RELEASE: As the parent or legal guardian of a participant in the AYSA program, I give consent for emergency medical care by a duly licensed Doctor of Medicine or Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

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