When

Monday, July 15, 2019 at 6:00 PM EDT
-to-
Wednesday, July 17, 2019 at 9:00 PM EDT

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Where

Roger Glass Stadium

351 S. Perry Street
Dayton, OH 45402

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Contact

Jeanne Spitzig
Chaminade Julienne Catholic High School
(937) 461-3740 x249
jspitzig@cjeagles.org

Chaminade Julienne Boys Soccer Summer Camp

Build your child or grandchild's summer activities with academic and athletic camps at CJ. Their days will be energized with activity, new friendships and personal achievement. With Christ at the center of our programs, you will begin to experience what it means to be a CJ student and athlete. GO EAGLES!

* Required information

Camper Information

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Parent/Guardian Information

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  • How did you hear about CJ Summer Camps? Check all that apply.

  • Fee

    Type Fee
    $100.00

New Camper Information (if registering more than 1)

You may add a maximum of 10

Part I - Consent to Participate, Consent to Treat & Photo Release

  • I hereby consent to the above named individual(s) attending a CJ Eagle’s Summer Camp. I fully understand that injury is always a possibility in any athletic event or activity and accept and assume full responsibility for all injuries and losses (both economic and non-economic), foreseen or unforeseen, that may occur. With this understanding, I release Chaminade Julienne Catholic High School, its trustees, officers, employees, camp directors and administrators from any and all liability in the event of accident or injury to the above named participant(s) from participation. By my clicking "I Consent" below, I warrant that my son or daughter is in good physical condition and has no undisclosed medical problems, illnesses or handicaps and is capable of full and active participation in the summer camp program. I also represent that my son/daughter, or, as guardian, my ward has received a physical within the last year and is medically competent to participate in the activities at camp.

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  • In case of a medical emergency, I understand that every effort will be made to contact me, the camp participant's parent or guardian.

  • In the event that I cannot be reached, please contact the individuals listed below who are permitted to act on my behalf:

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  • In the event that no one listed above can be reached, I hereby give my consent and authorization for administration of any treatment deemed necessary by the designated doctor, dentist or hospital of my choice, or in the absence of any designation, as determined by the person presenting this form.

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  • If the preferred physician or dentist is unavailable, I consent for treatment by another licensed physician, dentist or medical facility. This authorization doesn't cover major surgery unless the medical opinions of 2 other licensed physicians or dentists, concurring in the necessity for surgery, are obtained prior to the performance of surgery. Facts concerning the child’s medical history including allergies, medication taken, and any physical impairments to which a physician should be alerted.

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Part II - Refusal to Consent (do not complete if you completed Part I)

  • I do not give my consent for emergency medical treatment of my child.

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Electronic Signature

  • Chaminade Julienne Catholic High School requires you certify your online registration form by submitting an electronic signature.

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    By confirming my signature, I certify that all the information in my registration form is accurate and true.

$9,999.99

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