logosoccer-camps

 

2017 Registration
August 21-25

Mon-Fri   9am-3pm

Ages 6-12

$110 if registered before June 30  ($120 after)

After 2 children (over 3 per family) registered $15 per child extra. 

Athletes in Action (AIA) Canada is a division of Power to Change Ministries
 that focuses on the domain of sport.
Athletes In Action is committed to using the language of sport to communicate the most powerful message of all: God’s passionate love for his children as communicated through his Son, Jesus Christ. It’s a story that’s changed our lives, given us purpose and hope, and we long to tell this good news to others.
 
 
Payment can be made at the Church office Call: 780-349-4554
Or pay on-line with Push pay—–>   PUSHPAY
(Choose “payments” under giving type and Specify in memo “Soccer Camp” and for how many children)
 
* In the event of a rain day, camp will continue as normal over at the Westlock Rotary Spirit Centre * 

Child's Name (required)

MF

Parent's Name (required)

Address

Phone Number(required) (cell)

Your Email

Emergency Contact

Emergency Contact Phone number

I Authorize to pick up my child from camp.

Child's Age (required)

Child going into Grade (required)

Present school

How did you hear about this camp?

Shirt Size (required)

EMERGENCY INFORMATION
Your child’s heath and personal information is collected to ensure the safety and well-being of each person involved in our camp ministry. This information will only be seen by our camp staff and will be kept in a secure place.

Date of last Tetanus

Have you ever had or do you currently have?
SeizuresBack problemsHeart problemsNeck problemsAsthmaFainting spellssevere nose bleeds

Have you had any of the following in the last year?
Head injuryMajor surgeryOveruse injuryFractures

Please list any allergies

Please list any medications currently being used

List any other health problems/important information that could jeopardize camp safety:

I (parent/guardian) have read, understood and agree with the above and herby release and discharge all parties associated with this camp from any and all claims, demands, actions, and causes of action, that I/we or my/our child(ren) incur(s).

VIDEO/STILL PHOTOGRAPHY AUTHORIZATION FORM
I herby authorize the staff of the Athletes in Action to take video and still photos of my child during camp. These videos and still pictures will be used on AIA’s website and marketing materials as well as, youtube and facebook promotions. I understand they retain the sole right to use photos and video for publicity and advertising purposes.

Any additional information you would like to provide

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