MEN'S SOCCER PROSPECT CAMP

FORM DETAILS

















Camp rosters are FULL! We are no longer accepting registrations at this time.
 
If you have questions, please contact Tovi Eliasen, Assistant Coach.   
(805) 680-8757 
We are pleased to offer a Winter Prospect camp for recruits in grades 9-12. This camp will offer an immersive day experience into the Westmont Soccer program. Recruits are welcome to sign up for the date below:
 
Saturday, December 14, 2024
 
Camp roster space is limited! 
To reserve your spot submit this registration form as soon as possible! 
 
If you have questions, please contact:
  
Tovi Eliasen, Assistant Coach. 
teliasen@westmont.edu
(805) 680-8757
CAMP SELECTION
Camp registration is $150.
Saturday, December 14 is now FULL

Sunday, August 11 is now FULL

Saturday,
August 5 is now FULL

Sunday, August 6
 is now FULL
EVENT 5

Saturday, December 10 is now FULL 
ATHLETE








PARENT/GUARDIAN








ROSTER








ACADEMICS







PAYMENT
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CONSENT FOR EVENT ACTIVITIES AND TREATMENT

LIABILITY WAIVER
Consent for Event Activities and for Treatment
PARTICIPANT



EVENT INFORMATION

MEDICAL INFORMATION
Leave blank where not applicable.





PARENT/LEGAL GUARDIAN
If Participant a minor; preferred contact otherwise.










MEDICAL PROFESSIONAL


XXX-XXX-XXXX

XXX-XXX-XXXX

AUTHORIZED ADULTS
CONTACT ONE


XXX-XXX-XXXX

XXX-XXX-XXXX

XXX-XXX-XXXX
CONTACT TWO


XXX-XXX-XXXX

XXX-XXX-XXXX

XXX-XXX-XXXX
Behavioral Management

I understand that: 
a) behavior which disrupts the program or poses a threat to the safety of self or others will not be tolerated;
b) if Participant is unable to self-regulate their behavior then, after the event sponsor (or its agent) has made a good faith effort to resolve the issue (and, if Participant is a minor, consult with a parent or legal guardian), Participant may be removed from the remainder of the event; and
c) in such case there will be no refund of fees.
Authorization for Medical Care

If an injury or illness requires, in the opinion of the person in charge, urgent medical or dental
examination or treatment, I authorize and direct that person (or their agent) to:
a) arrange transportation by car or ambulance to the closest hospital;
b) call the Medical Professional/s named above; and
c) attempt to reach one or more of the other listed contacts.
If a named Medical Professional is unavailable, I authorize any emergency treatment deemed necessary by a medical professional licensed for the required service.
Acceptance of Circumstances & Assumption of Risk
I understand that Westmont College assumes no financial responsibility or legal liability for medical care or ambulance transportation. I also verify that the Participant is in sufficient health to be able to participate in the event identified above. I recognize that all physical activity has some risk of injury.
Image Release

I authorize the use, in future program publications, of biographical, image, video or audio content recorded for or during event activities and include this Participant.
Electronic Signatures

A signed copy of this waiver submitted via this form shall be deemed to have the same legal effect as delivery of an original executed copy of this waiver for all purposes.
SIGNATURE