St. Agnes Summer Camp 2026 - powered by Kolping Kicks Soccer Club

Powered by: Kolping Kicks Soccer Club

Dates: July 20th-22nd

Time: 6:00pm-8:00pm

Incoming Grade Level: PreK-8th

Player's Name

Player's Birthdate (mm/dd/yyyy)

Player's Incoming Grade for the 2026/2027 School Year

Guardian Name

Guardian Phone Number

(xxx) xxx-xxxx

Guardian Email

abc@gmail.com

St. Agnes Waiver: My child has my permission to participate in training and camp activities sponsored by St. Agnes Athletic Association. I approve of the leaders who will be in charge of this program. I recognize that the leaders and volunteer coaches are serving to the best of their ability. I certify that the participant has full medical insurance. I also certify to the best of my knowledge the participant named hereon is physically fit to engage in the activities described above. By entering my name below I am giving my permission.If, during the course of my daughters/sons activities in sports, she/he should become ill or sustain an injury, I hereby authorize you to obtain emergency medical/dental care. I will assume financial responsibility for the bills incurred through my insurance company. I release St. Agnes Catholic School and the St. Agnes Athletic Association along with its leaders and coaches of any liability. By entering my name below, I am agreeing to this statement of consent to medical care and release of liability.

WAIVER, RELEASE OF LIABILITY & ASSUMPTION OF RISK: I certify that my child is physically fit to engage in soccer activities with no other medical condition preventing participation. I accept that participating in the sport of soccer comes with inherent risks of physical injury including permanent disability, paralysis & death. I give consent for emergency treatment to preserve life, limb or well being. I agree that my child participates or spectates entirely at their own risk and agree that if at any time, I believe conditions to be unsafe, that I will discontinue my child's participation immediately. I consent to this soccer clinic to use photography or film footage which may include my child's image to be used solely for the promotion of the company. I hereby release and forever discharge this soccer clinic's staff, its owners, staff and field owners for any liability for any and all property damage and physical injury, and waive any and all rights, claims or causes of action including medical claims arising out of my child's participation in this activity. I certify that I have fully read this waiver and release of liability and assumption of risk, fully understand its terms and signed freely. I agree that if any portion of this agreement is to be held invalid, the balance shall continue in full force and effect. This waiver and release of liability and assumption of risk shall remain in effect for the duration of my child's participation and for any subsequent participation.*

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$60.00

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St. Agnes Summer Soccer Camp

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