* required Full Day Half Day AM Half Day PM  * required  * required  * required  * required Home Phone #: Work Phone #:  * required  * required Male Female Mothers Name: Fathers Name: My son/daughter is in good health and has my permission to participate in this program. In case of a medical emergency, I authorize Stacey DeCastro Soccer School personnel to seek medical emergency care for my child (player's name): I will not hold any facilities, Stacey DeCastro Soccer School, or any camp staff liable for injury to my child as a result of participation in the soccer school.  * required Emergency Contact: Contact Number: Medical Insurance: Policy Number: Physician: Physician Number: Known Allergies: Additional Information: