Camper's Name

Address

Parents Name

Primary Phone Number

Emergency Contact During Camp Hours

Contact Number For Emergency Contact

Phone Number

Date of Birth

Gender

Male
Female

Choose Your Summer Camp Type

How did you hear about us?

Registration Fee

$1.50

Total

$1.50

Coupon Code

Terms

Liability Disclaimer: In consideration of the Manchester Soccer School and the John Newcombe Ranch allowing my child’s/children’s participation in the camp, I for myself and my child/children release The Manchester Soccer School, The John Newcombe Ranch and their partners and affiliated officers, directors, agents and employees from and waive all claims, damages and liabilities whatsoever for property damage or loss personal injury or death arising from or in connection with my child’s/children’s participation in the camp. I agree that my son/daughter is amenable to discipline and is free from habits that would make him/her an undesirable camper. I agree that in the event of dismissal or withdrawal on account of homesickness, misconduct, or any other cause, except an illness requiring the attention of a physician, that I will pay for the camp in full. Unless withdrawal is advised by the camp physician, no refund will be allowed in any event. I understand transport to off-site fields may be required. I agree that Manchester Soccer School retains all rights to any video and photographs taken at the camp to be used for publicity or advertising.

I, the undersigned, agree to the terms above.

Camper Health Chart

Height

Weight

DPT Vaccination Date

Polio Vaccination Date

MMR Vaccination Date

TB Test Date

Tetanus Shot Date

Allergic/Reactions to Penicillin

Other Drug Allergies?

Food Allergies?

Special Conditions such as recurrent illness, fainting or heat exhaustion?

Special Instructions, such as medications that must be taken during camp? Please include drug names and dosage

Family Physician Name

Address

Physician Phone Number

If Family Physician is not available, relative or friend (other than parent) to be contacted in case of emergency

Phone Number

Please insure your child has proper medical coverage. The Manchester School of Soccer and John Newcombe Ranch will not be responsible for any medical expenses that may be incurred during their stay.

Medical Release and Waiver

I/We the parents of the above named camper, authorize the Manchester School of Soccer and/or the John Newcombe Ranch to arrange medical care for the above named camper while at the John Newcombe Ranch. I/We also hereby release the Manchester School of Soccer, the John Newcombe Ranch, their agents, employees, owners and officers from any claims for accident, injury or loss of valuables that may occur during my/our stay at the Ranch. My/Our online signature below acknowledges my/our release and waiver of any claims for damages from any such accident, injury or loss

I, the undersigned, agree to the terms above.

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