Soccer ID Clinic Registration Form

Soccer ID Clinic
















Waiver Statement
All Campers have their own medical coverage. The camp provides only excess coverage (does not cover deductibles or co pays) after your insurance policy has been utilized. Campers will not be allowed to participate unless the following information is submitted and the form sighed by the parent or guardian of the camper. I agree to hold harmless the RBSA for my voluntary participation.

I have read the above and agree to my childs participation.

(required)

Insurance Provider

(required)

Policy Number

(required)

I give my written permission for my child to be treated by a doctor if necessary.
They are physically fit according to our family doctor.

(required)


Total Price: $75