Women's Soccer Registration

Whitworth Intranet
Athletics
Women's Soccer Registration

The price is for this soccer camp is $150. Campers whose parent/guardian is a Whitworth faculty/staff member will receive a 20% registration discount.

Camper's Full Legal Name

Camper's Date of Birth

What year will you be graduating from high school?

City and State of origin

Camper's Email Address
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Camper's Phone Number

Camper's T-Shirt Size

Primary Position

Secondary Position

Upload a Headshot

Club Team Name

Parent's Contact Information

Parent or Guardian's Name

Permanent Mailing Address

City

State

ZIP/Postal Code

Phone Number

Email Address

Emergency Contact's Name

Emergency Phone

Insurance Policy Number

Medical Insurance Company

Insurance Policy Holder Name

Insurance Policy Holder Date of Birth

Please list any restrictions and/or health problems we should be aware of:

Name of Person Submitting Form

By clicking this checkbox, I testify that I am the parent/guardian of the listed camper and that I agree to the following statements:

I hereby give my consent to the Whitworth Soccer staff to attend to any health problems or injury my son/daughter may incur while attending this camp. Further, I give my consent for medical treatment and permission to the attending physician to hospitalize, secure proper treatment, and order injections, anesthesia, or surgery.
I will be responsible for any medical or other charges in connection with his or her attendance of camp.
I agree that neither I, nor my child, will bring any claims of any kind against Whitworth University or its staff, operators or sponsors as a result of any injuries, expenses or damages that my child may suffer in connection with my child's participation in the camp, whether such claims are known or unknown or arise in the future.

Total: $150.00