Registration and Medical
Medical Information
Please return this release form and camp
Payment
(Full payment required with registration form)
Release Form
Checks out to Highline College Women’s Soccer
Name: ____________________________
Age: ______ Team: _________________
Position: _______________
High School: ____________________
HS Grad Year: __________________
Parent’s Name:_____________________
Address:__________________________
_________________________________
City:____________________
ST:_________
ZIP:___________
Player’s Phone: ____________________
Parent’s Phone: ____________________
Email:____________________________
Emergency Contact: _________________
Phone: _______________________
(in case parents cannot be reached)
I certify that my child has had a physical exam in
the last six months and that the results of the
exam indicated that he/she is physically able to
participate in the strenuous activity associated with
a soccer camp. I agree that the participant and I
assume the risk for all injuries that may result from
participation in the camp. I further understand that
either minor or catastrophic sports injuries may
occur through no fault of the coaching staff and
that my child is covered by health insurance to
cover these injuries. I will accept all financial and
legal responsibility for any injuries that may result
from camp activities. I hereby authorize Highline
College as my agent to give consent to surgical
and medical treatment for the participant when
treatment is deemed necessary by the attending
physician.
Parental
Signature
Date
Camper’s
Physician
Phone
Name of Medical Insurance
Carrier
Policy Number
Camp Date(s)
Cancellation Policy:
If canceling within 14 days prior to the
start of camp the entire deposit will be
forfeited to cover costs. A $50.00 fee will
be assessed for cancellation of any kind.
Refunds take 4-6 weeks to process.
Please return (even if paying by Credit
Card) completed forms to the address
below:
SSE
23418 PACIFIC HWY S
PO Box 3703
KENT, WA 98032-9994
Have a Question? Contact
[email protected]