or PO Box
2nd Phone Contact
Parent Name Name(s)
On behalf of my child, and myself I verify that my child is in normal
health and capable of participating in the 2013 Eagle Soccer Clinic.
I further understand that participation in this camp involves risk
and possible injury.
I represent to the Eagle Soccer Clinic Staff and Bethlehem School
that my child has medical health insurance to cover any injuries
sustained as a result of participation in the program.
I authorize the Eagle Soccer Clinic Staff to secure emergency
treatment should my child require it.
I understand that I will be responsible for any expenses incurred
on my child’s behalf in connection with such treatment.