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2021 Youth Camp June 28-30th Registration

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
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Primary Phone


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Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date
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Home Address

T-Shirt Size

What size t-shirt for your camper? *

Liability Waiver

Recognizing the possibility of serious physical injury associated with soccer and in consideration of my child/ward's participation in the Dublin Jerome Girls Soccer Youth Camp, I HEREBY ACKNOWLEDGE THAT MY CHILD/WARD ASSUMES ALL THE RISKS ASSOCIATED WITH SUCH PARTICIPATION, I EXPRESSLY CONSENT TO SUCH PARTICIPATION BY MY CHILD/WARD AND I AGREE TO WAIVE ALL CLAIMS OF WHATEVER NATURE, fully and finally, now and forever, for my child/ward, for myself, my estate, my heirs, administrators, executors, assignees, and successors, and TO RELEASE, EXONERATE, DISCHARGE AND HOLD HARMLESS Dublin City Schools, it's affiliated booster organizations, all coaches, all assistant coaches, athletic trainers, as well as any other person, sponsor, employee, board member, agent, or associated personnel, providing services or assistance to the Dublin Jerome Girls Soccer Youth Camp from any liability, claims, causes of action or demands arising out of any injuries to my child/ward or to his or her property or losses of any kind which may result from or in connection with his or her participation in any activity related to the Dublin Jerome Girls Soccer Youth Camp. As the parent/legal guardian of the registered athlete, I hereby give my consent to have an athletic trainer provide medical assistance to my child/ward. I further authorize emergency medical transport and care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry and agree to be financially responsible for the cost of such care. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

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