Camper Name*

Full Address*

Current School*

Age*

Grade Entering (Fall 2025)*—Please choose an option—5th6th7th8th9th10th11th12th

T-Shirt Size*—Please choose an option—Youth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XL

My daughter has had a recent physical examination and is physically able to participate in all camp activities. I hereby release the camp directors and staff, Mercy High School and all its employees from all claims (present and future) resulting from injuries that may be sustained by my daughter while attending Mercy High School’s Soccer Camp.

Parent/Guardian 1 Name*

Parent/Guardian 2 Name

Phone*

Email*

Emergency Contact Name*

Emergency Contact Phone*

I understand that a camper is admitted only upon the expressed condition that she has accident insurance.

In the event that I am unavailable for purposes of providing parental consent, I hereby authorize the coaching staff at Mercy High School’s Soccer Camp or a physician to provide hospital care that includes routine diagnostic procedures and medical treatment as necessary to my child. I understand that this consent does not include major surgical procedures and is valid only during the Mercy Soccer Camp.

I confirm that all the statements provided in this form are true and accurate to the best of my knowledge.