Freedom Road Bible Church - 2018 Freedom Road Soccer Camp Registration

2022 FRBC Soccer Camp Registration

Please fill out one form for EACH of the children that you would like to register for Soccer Camp. Payment can be made on the first night of Camp at Bradley Field in Walden or before camp it can be brought to FRBC or mailed to: Freedom Road Bible Church 850 State Route 52 Walden NY 12586.

Child's Name*

Parent / Guardian Name(s)*

Full Mailing Address*

T-Shirt Size

Email Address*

Child's Age*

Child's Date of Birth*

Child's Grade (as of 9/1/22)*

Home Phone*

Cell Phone*

Name(s) of those allowed to pick up your child from Soccer Camp

Family Physician*

Family Physician Phone*

Specific medical allergies chronic illnesses or other conditions:*

Date of last tetanus shot*

As the parent/guardian I do herewith authorize treatment under the direction of any licensed physician of the following minor in the event of a medical emergency. This authority is granted after a reasonable effort has been made to reach the parent/guardian by phone at the number listed above. The undersigned assumes the responsibility for any costs connected with such treatment and hereby releases FREEDOM ROAD BIBLE CHURCH from any liability therefore. This release form is completed and signed with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.

Parent Signature*

Photographs are sometimes taken of children's ministry activities for publicity and promotional purposes which include but are not limited to in-house presentations church web site FRBC facebook page brochures and newsletters. Children's names or information are NEVER used without specific permission. By signing this area you are releasing FREEDOM ROAD BIBLE CHURCH to use photographs of your child as stated above.

Parent Signature*

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