Camarillo High School Girls Soccer

Camarillo High School Soccer Day Camp Registration Form

Thank you for your interest in the Camarillo High School Soccer Day Camp for 2018. Please fill out all of the required information below.

* indicates required

Participant's First Name *

Participant's Last Name *

Email Address *

Participant's Gender *

Birthdate( MM/DD/YEAR) *

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Guardian First Name *

Guardian Last Name *

Guardian Phone Number *

Guardian 2 First Name

Guardian 2 Last Name

Guardian 2 Phone Number

Participant Medical Conditions or Allergies *

Doctor's Name *

Doctor's Phone Number *

Preferred Hospital *

Medical Insurance Company and Policy Number *

Emergency Contact First and Last Name *

Emergency Contact Phone Number *

Emergency Contact's Relationship to Participant *

Is your child able to swim? *

Do you give your child permission to swim? *

Camarillo High School Soccer Day Camp 2018