Independent Baptist Church

Please complete the registration form below. If you have multiple children that you wish to register, please provide the requested information and submit for each child separately.

Child's First Name^*

Child's Last Name^*

Grade (child is going into)^*

Address

Address Line 1

Address Line 2

City

State or Region

Zip

Parent's First Name^*

Parent's Last Name^*

Phone Number^*

Email^*

Youth Shirt Size^*

Small
Medium
Large
Extra Large

Does your child have any food or medical allergies?^*

If "Yes", please list the food or medical allergies:

Does your child have any physical or medical conditions that may affect their well-being while engaged in a sports activity?^*

If "Yes", please explain:

Comments

I hereby give permission for my child to take part in the IBC Soccer Camp and absolve Independent Baptist Church from liability to me or my child because of injury to my child while attending. In case of emergency, I understand every effort will be made to contact the parents. In the event I cannot be reached, I hereby give permission to Independent Baptist Church to secure proper treatment for my child. I also grant permission to Independent Baptist Church to use my child's photograph(s) on its web site or Facebook or in other official church printed publications without further consideration.

Registration Fee^*

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Soccer Camp – Registration

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