Middle School Youth Soccer Camp

1 Contact Information

2 Camper Information

3 Waiver/Emergency Contact

4 Payment

Contact Information
Primary Contact Name*
Who should we be in contact with regularly about the registered camper?
First Last
Primary Contact Email*
Primary Contact Phone*
Address*
Street Address City State ZIP Code

Camper Information
Name of Camper*
Name of the child who is being registered for camp. If you have more than one child being registered, you will need to complete a registration for each one.
Date of Birth*
Grade (in Fall 2018)*
What is the camper's grade for the school year beginning in the Fall of 2018?
Middle school your camper will attend in Fall 2018
T-Shirt Size*
Health Issues*
Does this camper have any allergy or health concerns that we should know about?
- Yes
- No
Health/Allergy Concerns
Please let us know about any allergy or health concerns about this camper

Emergency Contact Information & Waiver
Name of Person to Contact in Case of Emergency*
Emergency Contact Phone*
Waiver Signature*
Type your name to indicate agreement to the following: My child has permission to participate in the Washburn High School summer soccer camp for middle school athletes on June 12-14, 2018. I hereby release and/or otherwise indemnify Washburn High School and its associated coaches and players against any claim by or on behalf of my child.

Payment
Youth Soccer Camp Registration Cost*
Price: $55.00
Discount Code
The discount code is supplied solely by Washburn Soccer Boosters after confirming a family qualifies for a discount.
Washburn Soccer Camp Registration
Total cost, including any applied discounts
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

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Middle School Soccer Camp Registration