SOCCER

Location:  May Whitney Fields

For the Summer of 2008 ONLY!

Fill out a separate registration for each camp and sign the waiver below.

Mail this completed form with payment, payable to:

LAKE ZURICH HIGH SCHOOL

C/o  Summer Athletic Camp

300 Church St., Lake Zurich, IL  60047

Student/Athlete’s Name____________________________________________________________

T-Shirt Size: (Please circle one)  Adult:   XL,     L,     M,    S   or  Youth:   L,    M,    S

Address:________________________________________________________________________

Home Phone Number:______________________________________________________________

Emergency Name:  ________________________________________________________________

Emergency Phone Number: _________________________________________________________

Camp Name:_________Soccer_________________________   Camp #______________________

WAIVER:

We/I, the parent(s)/guardian(s) of _____________________, a participant in the Lake Zurich Summer Camps, recognize and

acknowledge that there are certain risks of physical injury and we/I agree to assume the full risk of any injuries, including death,

damages or loss which may be sustained as a result of participating in any and all activities connected with or associated with this

program.  We/I agree to waive and relinquish all claims we/I may have as a result of our son/daughter’s participation in this program

against Lake Zurich Community Unit District 95 and its officers, agents, servants, and employees.

 _______________________________________         _______________________________

  (Signature of parent/guardian)                                       (Printed name of parent/guardian) 

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