Day Camp Registration Form

Soccer Clinic Registration Form

June 17th or July 8th
Camper's Information

Personal
Name

First NameLast Name
Birth Date

MonthDayYear
Age (at time of camp)
Grade (entering this fall)
Youth SmallAdult SmallYouth MediumAdult MediumYouth LargeAdult LargeYouth XLAdult XL
Did Child Play Fall 2022 for AYSO Region 1593 ?
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Name

First NameLast Name
Email
example@example.com
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Relationship to the Camper
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contacts and Authorized Pick Up Persons
Program Information

Program & Payment
Session One. Saturday, JUNE 17th. 8am-11amSession Two. Saturday, JULY 8th. 8am-11am
Session One $40Session Two $40Both $60T-Shirt Only $20
CashCheck- AYSO Region 1593 (14U Nationals in Memo line)
Terms & Conditions

I agree to pay fees and sign waivers before my child participates in clinic.
Date

MonthDayYear
Date
Should be Empty:

Soccer Clinic Registration Form