Chs Camp Registration Form

CHS SOCCER CAMP Hosted by CHS Girls Soccer Team & Staff

When: Monday, July 20th and Tuesday July 21st Rain-out Dates: July 22nd - 23rd

Candy League: 6 pm – 7:30 pm Cost: $20 All other divisions: 6 pm – 8 pm Cost: $25 ($20 each additional sibling) (T-shirt included with registration) Where: Carlisle SAY Soccer Fields

Please bring a ball and a full water bottle and wear cleats and shin guards every night! Please detach and mail registration form and payment by June 30th to: Jenny Henry 150 Nattix Crt. Carlisle, Ohio 45005 (checks should be made payable to: Carlisle Athletic Boosters) Late or on-site registrations accepted but T-shirt sizes may be limited For questions contact Jenny Henry at 746-8789 or Heather Allison at 743-0718 (keep top portion for your information)

------------------------------------------------------------------------------------------------------------------Player Name:_________________________________________________________ Address:_________________________________________________________ City:__________________________ State:______________ Zip:___________ Date of Birth:_____________________

Age: ________

Parent/Guardian Name:________________________________________________ Parent/Guardian Home Phone:__________________ Cell Phone:__________________ Shirt Size (circle one): YS (6-8) AXL

YM (10-12)

YL (14-16)

AS

AM

AL

Emergency Phone Number (in addition to numbers given above): Name: __________________________________ Number: _____________________ Please initial one of the following options and sign: _____ In the event that I cannot be reached should a medical problem arise, I hereby give my consent for treatment to the above named minor (including surgery, X-ray examinations and anesthesia) by a licensed medical practitioner. _____ I authorize limited care as follows:

___________________________________________________________________________________

Parent/Guardian Signature _____________________________

Date ___________