Participant's name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Sibling (if any)

First Name

Last Name

Date of birth (sibling)

MM

DD

YYYY

Parent's name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Camp weeks *

Please select the week(s) your child(s) is attending to camp. We will not have camp the week of June 30th to July 4th.

June 9th - June 13th

June 16th - June 20th

June 23rd - June 27th

July 7th - July 11th

July 14th - July 18th

July 21st - July 25th

July 28th - August 1st

Please check the box after reading: *

By checking this box I hereby provide my consent for my child's participation in all activities organized by Soccer Roots, during the chosen program. By accepting my child's participation, I acknowledge and accept all the potential risks and hazards associated with these activities. I release, exempt, and indemnify Soccer Roots, LLC and all its officials, representatives, and agents from any responsibility for injuries that may occur to my child during their training and game sessions. If my child sustains an injury, I waive any claims against Soccer Roots, LLC including its coaches, affiliates, fellow participants, supporting organizations, advertisers, and, if applicable, the owners and landlords of the premises where the event is held. Engaging in sports activities, including soccer or futsal, inherently carries a risk of injury, which may include but is not limited to fractures, paralysis, or even fatality. I also hereby provide consent to Soccer Roots, LLC to use photographs or videos of my child(s) named above for marketing and social media purpose.

ACCEPT