Soccer Camp

Sign Up for Soccer Camp!

Dates: August 4 - 8
Times: 0900 - 1200

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

How many kids are your registering?

1

2

3

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Relation to the child

First Child

First Name

Last Name

Age

Does this child have any allergies we need to be made aware of?

Yes

No

Please list any allergies

Does this child have any medication needing administered during while at VBS?

Yes

No

Please explain here

Do you have any other medical issues we should know about your child?

Yes

No

Please explain here

Second Child

First Name

Last Name

Age

Does this child have any allergies we need to be made aware of?

Yes

No

Please list any allergies

Does this child have any medication needing administered during while at VBS?

Yes

No

Please explain here

Do you have any other medical issues we should know about your child?

Yes

No

Please explain here

Third Child

First Name

Last Name

Age

Does this child have any allergies we need to be made aware of?

Yes

No

Please list any allergies

Does this child have any medication needing administered during while at VBS?

Yes

No

Please explain here

Do you have any other medical issues we should know about your child?

Yes

No

Please explain here

Medical Wavier

As a parent and/or legal guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor of the following minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me.

The release is intended for 4-8 August, 2025. This release form is completed and signed of my own free will and sole purpose of authorizing medical treatment under emergency circumstances in my absence.

I understand that neither MCIWEST-MCB Camp Pendleton Chaplain’s office nor any of its agents are responsible for any injury sustained by my child. I accept responsibility for any medical expenses as a result of any injury sustained. By signing this registration form, I agree with the medical disclaimer.

Signature

Parental Consent for Photography, Media and Websites

Photography

There may be photographs of your child(ren) taken by a volunteer associated with the MCIWESTMCB Camp Pendleton. Your authorization to use photos of your child in MCIWEST-MCB Camp Pendleton publications (brochures, newsletters, etc.) is requested.

Media Coverage

From time to time the media may cover our events. Whether or not you have concerns about your child(ren) participation in media coverage (being photographer, videotaped, interviewed) it is important that we know your wishes.

Websites

This tool is used to help the community and participants learn more about our program and activities. Participant photos may be posted on our website to show events and activities. If included, identification would be done by first and last name. Photos of large groups, or action photos where participants names cannot be identified, may be posted without parental permission.

Consent Wavier

By signing this consent form, I hereby authorize to allow my child/children to be:

Photographed (for MCIWEST-MCB Camp Pendleton use only)
Participate in media coverage (videotape/photographs/interviews)
Website usage (following the guidelines above)

Signature

Sign Up for Soccer Camp!

Dates: August 4 - 8 Times: 0900 - 1200

Emergency Contact

First Child

Second Child

Third Child

Medical Wavier

Parental Consent for Photography, Media and Websites

Photography

Media Coverage

Websites

Consent Wavier

Dates: August 4 - 8
Times: 0900 - 1200