Summer Soccer Camp Registration Form / July 7-10

* Please fill out a separate form for each player *

Player Information:
Name:
Age:
Gender:
Date of Birth: (mm/dd/yyyy)
Select your FREE camp shirt:
Camp Option:
Will you be registering more than one player:
Is this player currently a Dynamos Club member:

Parent/Guardian Information:
Name:
Home Phone: Work Phone: Mobile Phone:
Address:
City: State: Zip Code:
E-mail

LIABILITY RELEASE
I, the parent/guardian of the minor registrant, agree that in consideration for the registrant being allowed to participate in Oregon Youth Soccer Association (OYSA) and Hood River Dynamos Youth Soccer Club (HRDYSC) soccer programs and activities (referred to as PROGRAMS below) we agree to the following by submitting this waiver: The registrant and I agree to release, waive, discharge and indemnify OYSA and HRDYSC, from any and all liabilities, claims, demands or causes of action that may arise, by or on behalf of the registrant, from or related to any loss, damage, permanent disability or injury, including death sustained by the registrant while they are participating in the PROGRAMS and/or while the registrant is being transported from the same, which transportation I hereby authorize. This release, waiver, discharge and indemnification clause includes any claims for injury and death based on negligence of OYSA or HRDYSC. The participant and I are fully aware of the risks connected with participation in the PROGRAMS. These risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of my child, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials and monitors, and lack of hydration. I, therefore, expressly assume all of the foregoing risks and accept personal responsibility for maintaining the safety of my child.

CONSENT FOR MEDICAL TREATMENT OF MINOR (IN EMERGENCY)
As the parent or legal guardian of the registrant, I also certify by submitting this waiver that the registrant is in good physical condition and I have no knowledge of any physical condition, injury, or illness whatsoever that would place my child at risk to participate in HRDYSC PROGRAMS. I also hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of my dependent.