REGISTRATION FORM

I am registering for (circle one)   MINISOCCER   HALF DAY   TEAM CAMP  
               
Camper Name:   _____________________   Circle One:   M   F   Age ____   DOB _________
                           
Address: _______________________   City: _________________   St: ______   Zip: ________
                     
Day Phone __________________ Night Phone ___________________ E Mail _______________________
Enter X as appropriate
MINISOCCER   9:00 - 10:30am _____   $74.00
  10:40 - 12:10pm _____
           
HALF-DAY CAMP   Age 6 - 10   9:00am - Noon _____   $99.00
  Age 6 - 10   9:00am - Noon _____
               
TEAM CAMP _____   $149.00
       
Camp T-Shirt (circle size)   Y md   Y lg   A sm   A md   A lg   A xl
                         
Shinguards ($12.00 extra)   Youth 5-9     Junior 9+  
                         
_____ I have enclosed $30.00 deposit that is non-refundable (checks only)   Check # ____________
         
_____ I have enclosed the total amount due - $______________   Check # ____________

I hereby release Challenger British Soccer Camps from any and all claims and liability of any kind of personal injury or property damage due to participation in this camp. I certify that my child is in good health and is able to participate in all activities. If any attention is required for illness or injury, I give my permission to a staff member for such care. I give consent for my child to be photographed, videotaped or filmed while participating in camp activities and for the resulting images to be used by Challenger British Soccer Camps for promotional purposes. I understand that Challenger British Soccer Campswill attempt to make up for any time lost due to bad weather. However, if time cannot be made up, I understand that no refund will be provided.

Parent/Guardian Name _________________________   Signature _________________________