Elmira High School

Elmira High School

Soccer Camp Registration Form
July 20-23

9am-11:30am
Athlete Information
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Camp T-shirt
prevnext( X )
T-shirt size
Free Size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the athlete prescribed an inhaler? If yes, please explain any instructions.
Should be Empty: