Soccer Registration Form

PLEASE PRINT THE FOLLOWING INFORMATION
                 
Name of Camper: _____________________________________________Age:_________________
Parent(S) or Guardian(s): ___________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Address: __________________________________________________________________________
City, State, Zip Code: _______________________________________________________________
Home Phone: (___)_____________________________Business Phone:(___)_________________
Emergency Number(s): (___)_______________________________Cell :( ___)_________________
                 
      ** In case of emergency, I give permission to the camp administrators to authorize 
the necessary medical attention recommended by physicians or hospital staff.  
                 
____________________________________   ____________________________________
(Print Parent(s)/Guardian(s) name)   (Parent(s)/Guardian(s) signature)
                 
Has this athlete ever been medically advised not to participate in any sports?  
__________________________________________________________________________________
                 
Do you have any worries about the camper’s health or think there may be reason why the 
camper should not participate in the camps?        
__________________________________________________________________________________
                 
                 
I will assume all responsibility for injuries that my child may sustain during Camp.  
I hereby authorize the staff of the Howell PAL Camp to act for me according to their best
judgement in any emergency situation requiring medical attention and hereby release
the Staff and the Howell PAL harmless of any injuries or illnesses my child may have   
while attending the Camps.            
____________________________________   ____________________________________
Parent(s)/Guardian(s) Signature   Date
Within the last year – Please answer Yes or No.      
Sprains   If yes, where?      
Fractures   If yes, where?      
Dislocations   If yes, where?      
Concussions   If yes, where?      
Vascular/Nerve Conditions        
           
Other health conditions – Please answer YES or NO.      
Diabetes   Mononucleosis Heart Condition  
Epilepsy   Asthma Heat Related Conditions
Lyme Disease          
Other Conditions Medical Staff Should be aware of       
           
Allergies – Please answer YES or No.      
Hay Fever          
Insect Stings          
Medication(s) Player will be taking at camp:      
Parent/Guardian        
Signature          
 Email Address:____________        
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TEAR OFF          
GENERAL INFORMATION  – Hugh Hoffman Soccer Complex
1.  Arrive on time 6:00p.m.        
2.  Players should wear suitable clothing, and cleats.        
3.  Players should bring water bottles and ball with names on them.    
on bottles and ball.        
T-Shirt Size Small ___ Med_____ Lrg ____ XL______      
Send application and  Howell PAL      
checks payable to: PO Box 713      
    450 Adelphia Road      
    Howell, NJ 07731      
                                             Phone: 732-919-2825 – Fax 732-919-1212