Bulldog Soccer Camp

Registration

Registration Form 

Bedford Bulldog Soccer Camp

Please fill out the following registration form and include a check for $125 made payable

to Stuart Pepper and send to:

Stuart Pepper

91 Glenwood Ave,

Manchester, NH 03102

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Name_______________________________________

Bulldog Camp______   Puppy Camp_____ (Please check appropriate camp)

Age ____________        Grade in September 2012_______________

Address_________________________________________________________________

_______________________________________________________________________

Phone__________________________ Emergency____________________________    

-

Email__________________________________________________________________

Allergies_______________________________________________________________

Insurance Provider_____________________________ Policy#____________________

Circle T-Shirt Size:       S         M        L            XL

Children's Size:        S          M          L

Disclaimer: I hereby authorize the staff of Bedford Bulldog Soccer Camp to act for me

according to their best judgment in any emergency requiring medical attention and I

hereby waive and release Bedford Public Schools/Bedford Bulldogs Soccer Camp from

any liability for any injuries or illnesses incurred while participating at the facility or

property. I have no knowledge of any physical impairment that would affect the player’s

participation, named to the above, in the soccer camp.

Parent/Guardian (printed name): _________________________________

Parent/Guardian (signature): ____________________________________