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Soccer Sports Camp Registration

2019 SOCCER SPORTS CAMP
REGISTRATION FORM

JUNE 3 - 6
6 - 8:30 p.m.

Please use the form below to register your child for our Soccer Sports Camp.

Date
Date Format: DD dot MM dot YYYY
Child's Name
First Last
Gender
- Male
- Female
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Alternate/Emergency Phone
Date of Birth
Date Format: MM slash DD slash YYYY
School Grade Just Completed
Allergies?
Parent/Guardian Name
First Last
Family Church
Email
MEDIA/MEDICAL CONSENT

We/I consent to and approve the use of video and photographs of my child for ministry purposes by Heritage Baptist Church of Missouri City, Texas, with the understanding that such media use will not be identified with my child’s name. I grant to Heritage Baptist Church the perpetual rights to use and re-use photographs for printed and/or electronic formats including but not limited to brochures, newsletters, and website material.

We/I authorize the staff of Heritage Baptist Church to arrange medical transportation and care in the event of a medical emergency. We/I understand that in the event of a medical emergency, a representative of Heritage Baptist Church will contact me immediately. I release and hold harmless Heritage Baptist Church and its representatives from any claims or liability for authorizing medical care and transportation for my child.

Your registration of this form means that you consent to the above.
Name
This field is for validation purposes and should be left unchanged.