Washburn Youth Soccer Camp Registration

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*
Date Format: MM slash DD slash YYYY
Grade (in Fall 2019)*
What is the camper's grade for the school year beginning in the Fall of 2019?
School*
School the camper will be attending, beginning Fall 2019
T-Shirt Size*
Friend/Sibling Request
Does this camper have any friends or siblings attending the camp AND would like, if possible, to be paired with them? If so, please list any friends or siblings
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 on June 17-20, 2019. 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: $80.00
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
Comments
This field is for validation purposes and should be left unchanged.

Please contact us at [email protected] if you run into any trouble using our online registration. More information is also available on the Washburn Youth Soccer Ca mp page.

Mail-in registration is not yet available.

Registration