I want to sign up for
Chris Lawson’s Goalkeeper Camp put on by Western Missouri Soccer League, Inc.
Print this in your browser (File - Print), fill out and send along with your $75 check made out to “WMSL” to -
Western Missouri Soccer League, Inc.
6022 N. Antioch - Ste 2
Gladstone, MO 64119
Campers Name
_________________________________________________________________________
Age____________
Date of Birth _____________ MALE /
FEMALE (Circle one)
Address
______________________________________________________________________________
City, State, Zip
________________________________________________________________________
Home Phone ________________________________
Parent’s Name
________________________________________________________________________
Parental Consent and Wavier
Please provide the following information about the above named camper -
Allergic Reactions
____________________________________________________________________
Present Medications
__________________________________________________________________
Past illnesses or other information that would be useful in the event of
treatment, if necessary -
____________________________________________________________________________________
____________________________________________________________________________________
Emergency Telephone Number (Number that someone can be reached during camp
hours)
Phone ______________________________________________
I certify that my child is in excellent physical health and may participate in
strenuous and hazardous physical activities, including the soccer to be played
at camp. I certify that there are no physical limitations to my child’s
participation in the camp. Permission is granted for my child to receive
emergency medical treatment if needed. I hereby release and discharge Western
Missouri Soccer League, Inc. and all their affiliated entities from any and all
liability , claims, demands and causes of action for personal injury, property
damage and/or other loss suffered by my child in connection with his/her
participation in the camp.
I represent that I am a parent/guardian of the minor named above, and that I
agree that the grant and release contained therein binds me and the minor to all
of its terms.
Parent/Guardian Signature
_______________________________________________________Date __________________