Forms — BU Soccer Camp

Medical Form

Please fill out and sign this Medical/Insurance Form and Media Release at least a week prior to the start of your camp. Your camper cannot participate in camp unless the form has been received.

Soccer Camp Attendee

First Name

Last Name

Email

PHOTO / MEDIA RELEASE

I grant to BU Soccer Camp the right to use, reproduce, assign, and/or distribute photographs, films, videotapes, and sound recordings of my camper for use in materials they may create for camp promotional use.

MEDICAL / INSURANCE RELEASE:

AUTHORIZATION: I consider the above named camper to be in good health, and permission is granted to participate in all camp activities, unless otherwise indicated on this record. In case of illness and or injury, permission is granted for medical treatment to be rendered to my child.

WAIVER AND RELEASE

I do hereby waive, release and discharge BU Soccer Camp and respective staff and employees from any and all rights and claims for damages resulting from injuries to my child’s person or property which may be sustained or suffered by in connection with his/her association with or participation in, or arising out of my traveling to or from BU Soccer Camp. We, the parents or guardians, agree to the above waiver and release

Parent or Guardian Signature

by inputting your full name above you allow the attendee listed above to participate in BU soccer camp activities.

First Name

Last Name

Insurance Company’s Name

Policy Holder’s Name

First Name

Last Name

Policy Number

List any allergies to medications

List any pertinent medical info (diabetic, surgery, allergy…)

Family Doctor's Name

Family Doctor's Phone Number

Parent Cell Number 1

Parent Cell Number 2

Emergency Contact

First Name

Last Name

Emergency Contact Phone Number

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Camp

BU Soccer Camp (ages 5-14 years old)

ID Camp Series (High School)

High School Team Camp (Overnight)