* Parent's Name:

* Email:

* Address:

* City:

* State & Zip:

* Home Phone:

Work Phone:

Cell Phone:

* Child's Name:

* Child's Birth Date (mm/dd/yyyy):

* GenderMale:
Select OneMaleFemale

T-shirt size:

How did you hear about soccer camp?
Select OneRadioFlyerChick-fil-aChurchFriendOther

Does your child have any allergies or special needs?

* I will be paying by:
Select OneCheck to United A.C.Online Credit Card

Assumption and release of liability:
Participating in contact sports such as soccer are inherently dangerous. The undersigned, on behalf of the undersigned and the undersigned's child(ren) hereby assume the risk of personal injury, property damage, or other loss, to the Participant arising from or related to the activities conducted at soccer camp. You unconditionally waive, release, and discharge Reading United A.C. and Calvary Bible Fellowship Church and their agents, employees, staff members, officers, director, partners, members from all liability, claims, or responsibility for injuries to the participant. You grant permission for the participant to participate in the soccer camp and unconditionally release the Released Parties from injury arising from any good faith acts or omissions in emergency situations and give permission to the staff to call on emergency services in case of injury.. You represent that you are over the are of 18 or a parent/guardian of the child being registered, and agree that the grant and release contained therein binds me and the minor of all its terms.

* By typing your name, you agree to the above Registration Agreement: