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Summer MinI Day-Camp Registration
Rising K through Rising 3rd Grade
3 days only: $100
July 20, 21, 22, 9am-11am
Mike Chappell Park Carolina Beach NC
*
Indicates required field
Player Information
Name
*
First
Last
Gender
*
Male
Female
DOB
*
Enter XX / XX / XXXX format
Grade this Fall
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3
2
1
K
jersey size
*
Select Size Below
AL
AM
AS
YL
YM
YS
Street
*
City
*
Wilmington
Carolina Beach
Kure Beach
Wrightsville Beach
Leland
Shallotte
Southport
Other
Zip Code
*
Parent/Guardian Information
Parent Name
*
First
Last
Cell Phone
*
2nd Phone
*
Primary Email
*
Email will be used as primary communication. Make sure address is typed correctly.
2nd Email
*
By clicking the Submit button below, you agree to have read the following Liability Waiver & Medical Consent.
You will then be directed to the online payment page to complete the registration process.
We/ I, as the parent/legal guardian of the player named above, do hereby declare our intent to allow this child to practice, play, and participate in all programs and activities associated with the Pleasure Island Soccer Association, including any related activities and transportation. We/ I hereby release and hold harmless from any and all liability; Pleasure Island Soccer Association, its coaches, sponsors, associated board members and personnel, officials, or any others associated with this organization against any claim by or on behalf of the player’s participation in this program, including any COVID-19 related illness.
Any photos taken of players for player cards, team photos or action photos I give consent to PISA to use for website and purposes for exhibit & promoting PISA programs.
We/ I do hereby authorize Pleasure Island Soccer Association or any representatives including coaches, officials, or anyone associated with this organization, if after reasonable attempt has been made to reach the designated parent/guardian named above to consent, or if sound medical practice decrees that there is not time to make such an attempt, to consent to any x-ray, anesthetic, medical or surgical diagnosis or treatment or hospital care, to be rendered to the player under the general or special supervision and on the advise of any physician, dentist or surgeon duly licensed to practice, be indeed rendered to the Registrant.
Proceed to Payment