LSC Street Soccer Summer Camp On-line Registration
Please fill out one registration form for each player. If you have any questions, please email
lightningsoccerclub1983@gmail.com
. Thank you.
* Required
Player First Name
*
Player Last Name
*
Gender
*
Male
Female
Date of Birth
*
month/day/year
Camp Session Time
*
Please check
I understand that beginning 7/18 camp session time is from 10 am - 12 noon for all players.
Camp Location
*
Please check acknowledgement
Camp is located at Kimball Union Academy on Kilton Field (across driveway entrance from hockey rink - follow sign)
Exception: I understand that on Saturday, July 25th (ONLY) camp will be held at Huntley Meadows in Norwich, VT
Session Selection
*
For planning purposes, please let us know which days your player will attend.
All six days.
July 11
July 12
July 18
July 19
July 25
July 26
Town/city of Residence
*
State
*
Vermont
New Hampshire
Parent Email
*
Parent Phone
*
Please include area code.
Emergency Contact Name
*
Other than parent listed above.
Emergency Contact Phone
*
Please include area code.
Parent/Guardian Medical Treatment Authorization
*
I, the parent/guardian of the registrant, hereby certify that I understand that participation in sports camps includes physical contact and that my child/the registrant is in good physical health and may participate in any and all activities undertaken at the Lightning SC Street Soccer Camp. I agree to notify the coaching staff of any preexisting medical/psychological conditions. If attention is required for illness or injury, I hereby give permission to the camp to provide routine healthcare, to seek emergency medical treatment if needed, and to arrange necessary related transportation if required. In the event I cannot be reached in an emergency, I hereby give permission to the Director of Lightning SC Street Soccer Camp or their designee to administer, arrange and secure treatment as needed for the registrant named above.
Yes, I give authorization.
Yes, but I must discuss preexisting conditions with a member of the coaching staff.
Indemnification Agreement
*
I, the parent/guardian of the registrant, hereby agree to indemnify and keep harmless Lightning SC Street Soccer Camp, its agents, hosting organization and sponsors against any and all liability, claims, judgments, or demands arising as a result of any course of instruction or activity given the registrant by Lightning SC Street Soccer Camp.
Yes, I agree.
Publicity Release
*
I give my consent for my child to be photographed or videotaped while participating in camp activities and for the resulting images to be used by Lightning SC for promotional purposes.
Yes, I give consent.
No, I do not give consent.
Payment Information
The camp cost is $20 per session or $100 for all six sessions. Please bring a check or cash to your first session. Checks should be made payable to Lightning SC. Thank you.