MVCC Soccer Camps

First Name: Last Name: Enter your full address:

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Apt No./ Floor
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State		Zip code

Best Phone Number For Contact: E-mail address: Age
T-Shirt Size: Youth Sizes Available: YS YM YL YXL
Adult Sizes Available: S M L XL

Goalie Training: Yes No

I irrevocably grant Mohawk Valley Community College the right to photograph the named child, during camp activities, for the purpose of future advertising.**: Yes No

** Please click 'Yes' if you agree to allow to have your child photographed.

Parents Authorization: I understand that this camp requires a degree of physical activity and fitness. My child has had a physical recently and may participate in all activities at the mVCC Soccer Camp. In the event that I can not be reached in an emergency, I hereby give permission to the physician selected by the camp director to provide treatment for my child. I further agree that the camp staff, MVCC, and Oneida County, be held harmless from and indemnified against any and all liability, cost, claims, loss or damage which it may incur as a result of any accident or injury to my child. Please Initial and Date:

Utica 1101 Sherman Drive Utica, NY 13501 315.792.5400 Rome 1101 Floyd Ave., Rome NY 13440 315.339.3470
An equal opportunity educational institution affiliated with the State University of New York.
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