Name: __________________________________________Male/Female:_____________

Age:_______ Playing Experience:_________________(Years)

Camp: Basic Advanced Both

Phone:__________________________ T-Shirt Size: YS YM YL AS AM AL

Address:__________________________________________________________

City:______________________________

Zip:______________ Preferred Ball Size: 3 4 5

Emergency Phone:_________________ Parent/Guardian Name:______________________

Known Allergies:__________________________________________________________

Email Address: ______________________________________________________

As a condition of participation by______________________________________(player’s name), I accept all risks included in or incidental to camp participation. I release and hold harmless Grace Brethren Schools and Grand Prix Soccer Camps (including its coaches and directors). I also give consent for the care of injuries (which may include transportation to a medical facility) to the staff of Grand Prix Soccer Camps. I acknowledge that I have read and understand this precautionary and release from liability statement, I have adequate insurance to cover my player’s participation, and I consent to allowing the aforementioned player to participate in Grand Prix Soccer Camp.

Parent Signature:______________________________________ Date:________________________________