24-7 UK Soccer Academy

Camp Registration

PLAYER #1 INFORMATION

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Age

Sex

Male Female

Camp Name

Camp Dates

Camp Times

Medical Conditions (if any)

PLAYER #2 INFORMATION

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Age

Sex

Male Female

Camp Name

Camp Dates

Camp Times

Medical Conditions (if any)

PARENT/GUARDIAN INFORMATION


Name (first, last)
Phone (home)
Phone (cell)
Address
City
State
Zip

I have signed a 2010 medical release waiver for my child.
I need a 2010 medical release waiver for my child.
(A link to download the waiver will be provided after submitting this form.)

*Note: Waiver covers child for all activities for 2010.

Please add any additional comments or suggestions.

Please check if you do not wish to receive any information about 24-7 UK Soccer Academy

Your Name:

Your E-Mail Address:

Please mail in payment and signed medical release waiver upon completion of this application to:

24-7 UK Soccer Academy
4061 East Castro Valley Blvd, # 447
Castro Valley, CA, 94552

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