2019 Manheim Township
Youth Soccer Camp June 17th-20th 6:00pm-8:00pm
Manheim Twp. High School Turf Fields
Who: Boys and Girls Ages 5-11
Where: Manheim Township High School turf fields I and J (behind the arena) Cost: $82.00 Due by May 29, 2019 ($92.00 after May 29th *T-shirt not guaranteed)
Two ways to register!
For questions or further information contact Noel Johns at email@example.com
Name_________________________________________________Age:____Gender:_______ Parent(s)/Guardian(s) Name:_______________________________________________________________ Address______________________________________________________________________________ Street City State Zip Phone:__________________________________ Email:_________________________________________________ Emergency Contact Name:__________________________________________ Phone #:_________________________ T-shirt Size: (circle one) YS, YM, YL, AS, AM, AL, AXL Medical Release Form:
I understand that Manheim Twp. School District does not carry medical or accident insurance for campers and I hereby certify that _______________________________ is covered by an insurance policy and that neither Manheim Twp. School District, Manheim Twp. Soccer camp volunteers, nor the Corner Kick Club, will be held financially responsible for any injuries to the above named camper. Further, I hereby authorize treatment to be referred to local physicians and medical facilities at my own expense.
Parent/Guardian Signature:_________________________________________________________ Date:_____________________