Soccer Camp 2022

Insurance Information
Carrier*
Policy Holder's Name*
First Last
Policy #*
Group #*
Emergency Contact other than parent
First Last
Phone
Medical Release: I, the undersigned, in the event of an injury, authorize the appropriate camp personnel to administer first aid or care as deemed necessary. I release Christian Brothers Academy, the camp staff, its officers and any representatives of any claims for damages to persons or property while at the camp.
Signature*