Event Services & Camps - Camp Registration


CAMP REGISTRATION

2018 Men's Soccer Summer ID Camp
Saturday, August 4th 2018 | 10:00am-4:00pm



Player Information

*First Name
*Last Name
*Home Address
*City
*State
*Zip Code
*Email Address
Please note that all electronic correspondence will be sent to this address.

*Grade - Fall 2018
*Date of Birth (mm/dd/yyyy)
Current Club Team
Position


Emergency Contact Information

Contact #1
Must have authorization to make medical decisions for player. If player is under 18, parent or guardian must be listed.

*Name
*Relationship to Player
*Primary Phone Number ### ###-####
*Phone Type HomeWorkCell
Secondary Phone Number ### ###-####
Phone Type HomeWorkCell
*Has permission to make medical decisions for player? Yes


Contact #2
Name
Relationship to player
Primary Phone Number ### ###-####
Phone Type HomeWorkCell
Secondary Phone Number ### ###-####
Has permission to make medical decisions for player? YesNo


Insurance Policy Information

*The above-named player is covered by health insurance Yes

Please provide the following information which is required to expedite treatment should the player require care at a local medical facility.


Policy Holder Name
Relationship to player
Insurance Company


General Health Information

Saint Mary's University of Minnesota requires all players to be immunized against certain diseases.

*Does camper have any allergies?
Please list any allergies



Special Instructions
(i.e. recent injuries, activity limitations)




Player Waiver

Covers:

  • Informed Consent
  • Liability Release
  • Medical Treatment Authorization
  • Photo Release

Read Waiver before proceeding. Waiver opens in new tab or window.



*I have read and understand the waiver.

I understand that submitting this form serves as my electronic signature.




This registration cannot be processed without payment in full.

After submitting this form you will directed to our secure online payment gateway where you can pay the registration fee.

* Required Fields

 
OFFICE OF EVENT SERVICES & CAMPS

Event Services | 700 Terrace Heights #47 | Winona, MN 55987-1399 USA
800-635-5987, Ext 6921 | 507-457-6921 | eventservices@smumn.edu | www.smumn.edu/camps