HS Team Camp registration

Fields marked with * are required.

School

Your high school *

Player

First name *Last name *Player emailDate of birth *Grade in the fall *Graduation yearT-shirt size *

Parent/Guardian & Emergency Contact

Parent/guardian full name *Home phoneCell phone *Parent/guardian email *Home address *Emergency contact name *Emergency contact phone *

Medical & Insurance

Health insurance company *Insurance policy number *Group policy numberPolicy holder (parent name) *Insurance company phone

For the next five, leave "None" if there is nothing to report.

Previous injuriesSpecial medical needsMedications takingAllergiesDietary restrictions

Staying in touch

Send me news about future Premier Soccer Company camps and tours. Optional, and it does not change the emails about this registration.

Waiver

High School Team Camp waiver and release

I give permission for the player named above to participate in the Premier Soccer Company High School Team Camp. I understand soccer carries a risk of injury, authorize emergency medical treatment if needed, and confirm the medical and insurance information provided is accurate.

I waive and release Premier Soccer Company LLC and its staff from all liability for injuries that occur at the camp. All medical expenses will be the responsibility of the above minor and the minor's parents and/or guardian. Any items that are lost or stolen are not the responsibility of Premier Soccer Company LLC or its staff. Any pictures or video taken at the camp may be used by Premier Soccer Company LLC and Ashland University for promotional purposes.

I agree to the waiver above as the player's parent or legal guardian. *Typed signature (parent/guardian full legal name) *