• • Name of Camper *
    
    First
    
    Last
• • Address
    
    Street Address
    
    Other Address (optional)
    
    City
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    Zip/Postal Code
    
    Region (optional)
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    Country
• • Phone Number *
    
    
    
    
    
    
• • Gender
    Male
    Female
    
• • Date of Birth
    
    
• • Grade entering in Fall
    ...Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade
    
• • T-Shirt Size
    ...Youth XSYouth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult XXLAdult 3XL
    We cannot guarantee you will recieve the size requested, but we will do our best)
• • Did you play Spring or Fall Soccer for Newberg Soccer Club or CPRD?
    ...YesNo
    
• • Email
    
    
• • Parent/Guardian *
    
    First
    
    Last
• • Phone Number
    
    
    
    
    
    
• • Email
    
    

• • Emergency Information
• • Emergency Contact *
    
    First
    
    Last
• • Emergency Phone Number *
    
    
    
    
    
    
• • Doctor's Name
    
    
• • Doctor's Phone Number
    
    
    
    
    
    
• • Medical Insurance Provider
    
    
• • Group Number
    
    
• • Policy Number
    
    

• • Liability Waiver

    I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the Newberg Christian Church, Sports Outreach Institute, its affiliated organizations, and sponsors. Recognizing the possibility of physical injury associated with soccer and inconsideration for the Newberg Christian Church accepting the registrant for its soccer programs and activities, I hereby release, discharge, and/or indemnify the Newberg Christian Church, Sports Outreach Institute, and its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as result of the registrants participation in the programs and/or being transported to or from the same, which transportation I hereby authorize. As a parent or legal guardian of the above named registrant, I hereby give consent for emergency medical care prescribed by a duly license
• • Liability Waiver Agreement *
    I acknowledge reading the information provided and (where applicable) agree to the published waiver.
    

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