Team America Soccer Club

1

Is your family registered with Team America Football Club?* This field is required.

YESNO

2

How many players are you registering for camp?* This field is required.

3

Player 1 - Name* This field is required.

First Name

Last Name

4

Player 2 - Name* This field is required.

First Name

Last Name

5

Player 3 - Name* This field is required.

First Name

Last Name

6

Player 4 - Name* This field is required.

First Name

Last Name

7

Player 5 - Name* This field is required.

First Name

Last Name

8

Player 1 - Date of Birth* This field is required.

Date

9

Player 2 - Date of Birth* This field is required.

Date

10

Player 3 - Date of Birth* This field is required.

Date

11

Player 4 - Date of Birth* This field is required.

Date

12

Player 5 - Date of Birth* This field is required.

Date

13

Player 1 - Gender* This field is required.

14

Player 2 - Gender* This field is required.

15

Player 3 - Gender* This field is required.

16

Player 4 - Gender* This field is required.

17

Player 5 - Gender* This field is required.

18

Player 1 - School* This field is required.

19

Player 2 - School* This field is required.

20

Player 3 - School* This field is required.

21

Player 4 - School* This field is required.

22

Player 5 - School* This field is required.

23

Parent/Guardian 1 - Name* This field is required.

First Name

Last Name

24

Parent/Guardian 1 - Phone Number* This field is required.

25

Parent/Guardian 1 - Email* This field is required.

example@example.com

Email Verified

Confirm Email

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

26

Parent/Guardian 1 - Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

27

Would you like to list a 2nd Parent/Guardian?* This field is required.

YESNO

28

Parent/Guardian 2 - Name* This field is required.

First Name

Last Name

29

Parent/Guardian 2 - Phone Number* This field is required.

30

Parent/Guardian 2 - Email* This field is required.

example@example.com

Email Verified

Confirm Email

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

31

Would you like to list an Emergency Contact?* This field is required.

YESNO

32

Emergency Contact - Name* This field is required.

First Name

Last Name

33

Emergency Contact - Phone Number* This field is required.

34

Permission to Swim?* This field is required.If registering multiple children and one or more cannot swim. Please let the camp administrator know during check-in..

YESNO

35

Camp Session* This field is required.Select when you would like to attend. Multi-week price is $165/week.

Spring Break: April 14th - April 18th

Session #1 June 23rd - June 27th

Session #2 July 7th - July 11th

Session #3 July 14th - July 18th

Session #4 July 21st - July 25th

Session #5 July 28th - August 1st

Session #6 August 4th - August 8th

Session #7 (Team Camp Week): August 11th - August 15th

36

Late Pick-up?* This field is required.How many days per week will you need late pick up?

Cost per player is $5/day

37

WAIVER

As parent or guardian of the child or children registered hereon, we hereby approve his/her participation in this activity including, but not limited to soccer training, swimming, bowling, scrimmaging. I/we hereby assume all risks and hazards of such participation, including transport to and from the activity. I/we do hereby waive, release, absolve and agree to indemnify and hold harmless TASC, TAFC, TAAFC and Fairfax Sportsplex its directors, officers, supervisors, coaches, trainers, referees, and other participants and persons providing transportation to or from activities for any claim or right arising out of any injury to said child. I/we have read the foregoing release and agreement, understood it, and signed it voluntarily.

SIGN ON THE NEXT SCREEN

38

WAIVER - Parent/Guardian Signature* This field is required.

Clear

39

Referral

40

number_weeks

41

camp_price

42

camp_subtotal

43

pickup_subtotal

44

price_total

45

total_w_fee

46

Camp Registration Fee* This field is required.Includes 3.3% Processing Fee

USD

+ OR enter a custom value

47

Does Billing Address Match Parent/Guardian Address?* This field is required.Card payments cannot be processed if the Billing Address does not match what is on file for the card. Registrations are not submitted without a valid payment.

YESNO

48

Billing Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

49

Payment Methods

Debit Or Credit Card

Please click one of the PayPal options to complete payment and submit the form.