Camp Registration USA.

LAKPAZEE YOUTH SOCCER ACADEMY Soccer Camp Registration, Consent & Waiver Form

Camp Name: _______________________________
Camp Dates: _______________________________
Location: _________________________________

1. Player Information

• Player Name: ________________________________________

• Date of Birth (DD/MM/YYYY): __________________________

• Age: ______ Gender: ☐ Male ☐ Female ☐ Other

• Address: ____________________________________________
  City: _____________________ State: ______ Zip: ________

2. Parent / Guardian Information

• Parent/Guardian Name: _______________________________

• Phone (Primary): ____________________________________

• Phone (Emergency): __________________________________

• Email Address: ______________________________________

3. Medical Information

• Family Doctor: ______________________________________

• Doctor Phone: _______________________________________

• Does the player have any medical conditions (asthma, allergies, injuries, etc.)?
  ☐ No ☐ Yes – please describe:

• List any medications the player is currently taking:

• Does the player have any allergies (food, medication, insect stings, etc.)?
  ☐ No ☐ Yes – please describe:

• Date of last tetanus shot (if known): __________________

4. Emergency Contact (Other than Parent/Guardian)

• Name: _____________________________________________

• Relationship: ______________________________________

• Phone: _____________________________________________

5. Consent for Participation

I, the undersigned parent/guardian, give permission for my child named above to participate in all activities of the Lakpazee Youth Soccer Academy camp, including practices, drills, games, and related events.

I understand that participation in soccer involves physical contact and inherent risks of injury. I certify that my child is in good physical condition and able to participate fully in the camp. I agree to inform the camp organizers of any changes in my child’s health.

6. Medical Treatment Authorization

In the event of illness or injury and if I cannot be reached, I hereby authorize the camp staff, coaches, and representatives of Lakpazee Youth Soccer Academy to obtain emergency medical treatment for my child, including transportation by ambulance if necessary. I understand that I am responsible for all medical costs incurred.

Parent/Guardian Initials: _________

7. Liability Waiver & Release

I understand and acknowledge that participation in the soccer camp may result in personal injury, property damage, or other loss. In consideration of my child being allowed to participate, I hereby:

• Assume all risks associated with participation in the camp; and

• Release, discharge, and hold harmless Lakpazee Youth Soccer Academy, its owners, directors, coaches, staff, volunteers, sponsors, and facility owners from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury (including death) that may be sustained by my child or by me, whether caused by negligence or otherwise, while participating in or traveling to/from the camp.

Parent/Guardian Initials: _________

8. Media / Photo & Video Consent

Lakpazee Youth Soccer Academy may take photos and videos during the camp for training, promotion, and social media.

Please choose one:
☐ I give permission for my child’s image, name, and likeness to be used in photos, videos, and promotional materials (website, social media, flyers, etc.).
☐ I do NOT give permission for my child’s image to be used.

Parent/Guardian Initials: _________

9. Code of Conduct

I understand that my child is expected to:

• Show respect to coaches, staff, teammates, opponents, and referees

• Follow all rules and instructions given by camp staff

• Demonstrate good sportsmanship at all times

I understand that failure to follow the code of conduct may result in removal from the camp without refund.

Parent/Guardian Initials: _________

10. Payment & Online Registration

To complete registration and secure a spot:

1. Go to our registration & payment page:
   Registration Link: _________________________________
   (For example: https://lakpazeeyouthsocceracademy.com/camps-registration)

2. Complete the online form and make payment for your chosen camp session(s).

3. Submit this signed consent form:

   • ☐ Upload it during online registration, or

   • ☐ Print and bring it on the first day of camp.

11. Acknowledgment & Signature

By signing below, I confirm that:

• I have read and understood this form in full

• I am the legal parent/guardian of the child named above

• All information provided is accurate to the best of my knowledge

Parent/Guardian Name (print): _______________________

Signature: ________________________________________

Date: _____________________

https://lakpazeeyouthsocceracademy.com/camp-registration-usa