Panda Soccer Camp Interested in improving your skills? Dates/Times: June 5th-8th 9-11:30 am *Please bring water and a towel!! Location: Pershing Soccer/baseball Fields 3838 Blue Bonnet Hosted By: Coach Ortiz Cost: $120 incoming 5th, 6th, 7th, or 8th grade boys and girls Cash only please! Payment due by Friday June 1st 2018. Cost will includes a camp t-shirt and a soccer ball. Please email or turn in your registration form to Coach Ortiz before Friday June 1st 2018 jortiz3@houstonisd.org Athlete name: _________________________________ Grade 2018-2019: ____ T-shirt size: YL AS AM AL XL Parent /Guardian Name: ______________________________________________ Phone Number: _______________ email: ________________________________ Secondary contact (name and phone #): __________________________________ ___________________________________________________________________ WAIVER & PROOF OF INSURANCE, PICK UP POLICY (required) I hereby authorize the camp staff to act for me, according to their best judgment, in any emergency requiring medical attention, and hereby wave and release the Panda Soccer Camp from any and all liability for any injuries or illnesses that may occur while at camp. I have no knowledge of any medical problem or physical impairment that would effect the above named camper to safely participate in the camp program. I certify that the above named camper is covered by a medical insurance policy in case of injury or illness. All camp participants must be picked up by 15 minutes after the end of camp-any late pick ups will result in immediate disqualification of the camper for all future camp activities. MEDICAL INS. COMPANY____________________________POLICY #_____________ SIGNED (PARENT/GUARDIAN)______________________________DATE__________