Windy City Pride Soccer Club Camp Sign-Up Form

Print out and send along with check made out to the Windy City Pride Soccer Club  and mail to 24330 Norwood Dr. Plainfield, IL 60585:  

                                                                               ____ $80 - Summer Camp

                                                               ____ $70 - Preseason Camp (if player attends Summer Camp)

                                                                                                         ____ $80 - Preseason Camp (if player does not attend Summer Camp)

                  Age Group _________ Team Name ______________ 

Name:__________________________________________________

Address:_____________________________________________________________________________________

City: __________________________ State:______ Zip: ___________________ Phone:______________________

Players/Parents Email: __________________________________________________________________________

Mother's Name:________________________________________ Cell Phone: _____________________________

Father's Name: ________________________________________ Cell Phone: _____________________________

Emergency Contact: 

Name: ________________________ Phone: _______________________ Cell: ___________________________

Any Medical Concerns/History: ________________________________________________________________________________________

_________________________________________________________________________________________________________________

I hereby give permission and certify that my child is in good health and able to participate in all Windy City Pride Soccer Club/Just Kickin Activities. I release coaches, staff, and all others associated with the Windy City Pride Soccer Club of all Liability for any injury or illness incurred by my child at the Windy City Pride Soccer Club/Just Kickin Soccer Camp. In Case of an emergency, I give permission for my child to be given emergency treatment at a local hospital, and acknowledge that I will take full responsibility for the expenses. I further release coaches, staff, and all others associated with the Windy City Pride Soccer Club of any illegal recruitment/tampering associated with the camp, and that I have informed the team that I am currently registered with of my participation, intentions/actions.

Player/Parents Signature (if player is under the age of 18):_________________________________________________________________________________  

Date:_____________________