CFC Sports Soccer Camp
July 15-19, 5-8pm Ages 5-12 CFC Madrid, NY $30
Camper Name
*
Camper Age
Completed grade 2018/2019
*
Please Select
Pre-K
Kindergarten
1st
2nd
3rd
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5th
6th
T-Shirt Size
Choose Size
Youth Small
Youth Medium
Youth Large
Adult Small
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Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.
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Parent's Information
Parent/Guardian
Parent/Guardian
*
First Name
Last Name
Relationship to Child
*
E-mail
*
Home Phone
Cell Phone
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Emergency Contacts/Authorized Pickup
Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached.
Emergency Contact
Information
Full Name
*
First Name
Last Name
Primary Phone Number
*
Secondary Phone Number
Relationship to Child
*
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Medical / Health Information
Name of Physician or Clinic/Hospital
Phone Number
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Does your child have any food, medication or environmental allergies?
*
Yes
No
Allergies? Check all that apply
Food
Medication
Environmental
Please list and explain any allergies
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Does your child have a special health or medical condition?
*
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No
Please explain
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Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
*
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No
Please explain
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List any additional information about your child that would be useful for staff to know.
*
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Payment and Statement of Understanding
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CFC Sports Soccer Camp
$
30.00
Total
$
0.00
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Date Signed
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