Parent/Guardian Details

Registration Form
Choose Camp
Participant Name

FirstLast
Participant Date of Birth

MonthDayYear
Participant School Grade
If camp will take place in summer break, select the participant's rising grade.
Participant Graduation Year
.
Participant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant T-Shirt Size
Participant Club Team
Participant Primary Position

GoalkeeperWide DefenderCenter DefenderDeep MidfielderAdvanced MidfielderWide ForwardCenter Forward
Medical Information
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Participant Insurance Provider
Participant Insurance Provider Phone Number
Participant Insurance Policy Number
Participant Insurance Holder Name
Participant Medications
Participant Allergies

Would you like to register the CURRENT participant for an additional camp?

YesNo

Total Amount

USDDescription

Registration Form