Indoor Soccer Camps 2019

Winter Camp 2020
Camper's Information
Member ID
Camper Name *

Last Name
Date of Birth *

Month Day Year
Age
NOTE - Children must be at least 5 years old.
T-Shirt Size *
If you register after Dec. 14th you might not receive a shirt due to time constraints
How did you hear about our camp? *
Parents' Information

Parent/Guardian 1
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Cell Phone *
Emergency Contacts/Authorized Pickup

List the name of at least one person other than yourself who can be contacted in the event of an emergency if you cannot be reached. Any person listed should be able to assist in contacting you and must able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact
Full Name *

First Name Last Name
Primary Phone Number *
Relationship to Child *
Medical / Health Information
Name of Physician or Clinic/Hospital
Does your child have any food, medication or environmental allergies? *

Yes No
Allergies? Check all that apply *

Food Medication Environmental
Please list and explain any allergies *

0/150
Does your child have a special health or medical condition? *

Yes No
Please explain *

0/150
Is your child currently using any medication, food supplement or medical food? *

Yes No
Please explain *

0/150
Have you or anyone in your household presented COVID-19 symptoms in the last 15 days? E.g. fever, cough, shortness of breath, body aches, loss of taste or smell, etc.

Yes No
Camp Payment
10% sibling discount is available, applied to the second sibling only. Must enroll at least 2 children. Use code Sibling10

If you are an active member of our Dynamic Youth Soccer Academy use discount code DISAcademy for 15% off!!

Coupon codes cannot be combined

My Products

3 Day Camp $ 135.00

Mon, Tues & Wed

Enter coupon

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Lunch
Due to covid-19, and out of an abundance of caution, we are no longer selling lunch that must be cooked/prepared.

Each child has to bring their own lunch.

We will still give an afternoon snack which consists of fresh fruit and goldfish crackers.
Our Food vendor is now offering lunch packages for purchase. If you would like to purchase any, please select on the drop-down list below.

Each lunch is $6

Payment for the lunch packages must be done in person and is due on your first day of camp in the morning when dropping off.

Vegetables available are mini carrots, cherry tomatoes, corn, and peas.
Cheese Pizza & veggies
Select how many
Hot Dog, French fries & veggies
Select how many
Cheese Nachos & veggies
Select how many
Chicken nuggets, chips & veggies
Select how many
Mac&Cheese & veggies
Select how many
Statement of Understanding
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Winter Camp 2020

Camper's Information

Parents' Information

Emergency Contacts/Authorized Pickup

Medical / Health Information

Camp Payment

Lunch

Statement of Understanding