SUMMER SOCCER REGISTRATION 2022

For children from Kindergarten to Grade 8 as of the new school year in September 2022.
Dates: Tuesdays from July 5 to August 9 Time: 7pm Cost: Free Location: Centralia Faith Tabernacle
Requirements: Water bottle, running shoes and a great attitude! Parents/guardians of Kindergarten to Grade 1 are asked to stay on the field from 7-8pm until your child(ren) are released.

Parent/Guardian Name

First Name

Last Name

Email Address

Address

Primary Phone Number

(###)

###

####

Family Doctor

Emergency Name + Contact Number

First Child's Information

Child's Name

First Name

Last Name

Grade in September 2022

Health Card Number

Please list any allergies or medical conditions

Second Child's Information

Child's Name

First Name

Last Name

Grade in September 2022

Health Card Number

Please list any allergies or medical conditions

Third Child's Information

Child's Name

First Name

Last Name

Grade in September 2022

Health Card Number

Please list any allergies or medical conditions

Fourth Child's Information

Child's Name

First Name

Last Name

Grade in September 2022

Health Card Number

Please list any allergies or medical conditions

Release of Care

According to our Plan to Protect Policy your signature releases the care of your child(ren) over 12 to Centralia Faith Tabernacle from the time they are dropped off at CFT until they are picked up by a parent/guardian. This consent recognizes that all reasonable precautions will be taken to prevent accidents or injuries. Permission is given to allow supervision to seek emergency medical treatment. I have read and understand the Privacy Policy and Release of Care Policy above and I hereby acknowledge on behalf of my son/daughter to absolve the church for any liability whatsoever. PRIVACY POLICY Any personal information given will not be used or disclosed except for the purpose of the Summer Soccer program at Centralia Faith Tabernacle. Pictures and/or names of children may be used for the purpose of promotion, celebration and to give information both in-house and on our social media sites. To protect the privacy of our children, no names will be listed or tagged by CFT. Email will be used strictly for Summer Soccer purposes informing about upcoming events, cancellations, or changes occurring.

Consent

Consent is given for my child(ren) to participate in Summer Soccer

Consent is given to take pictures and videos of my child(ren) in accordance with the privacy policy.

Type your name here to consent

By typing your name and submitting this form you are agreeing to all of the policies listed above.