Summer On-Line Registration

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SUMMER CAMP REGISTRATION FORM

Please Note *****All applicants must complete the Insurance and General Information sections of the Registration form. Failure to do so, will void your application.

Session Please select week:
Player Info:
Camper Name:
DOB: Gender:
T-Shirt Size: Previous Camper:
Player Position: Playing Level: 
Street address:
City:
State:
Zip/Postal code:
Parent/Guardian Information:
Parent/Gaurdian Name:
Home Phone:
Cell Phone:
Primary Email:
Alternate E-mail:
Insurance Information:
Camper's Insurance Company:
Policy Holder:
Policy Number:

Doctor/Parent/Guardian Permission: This will certify that the camper is physically qualified to attend the Camp listed in the application. Should there be any medical conditions, you must bring them to the attention of the MSA Staff.

Message/Special Instructions:

 

***** INSURANCE INFORMATION MUST BE COMPLETED BY ALL APPLICANTS! *****

Make Checks Payable To: Metros Soccer Academy

Mail $195 payment with Player's name to:

Metros Soccer Academy - 106 Fairfield Court - Chapel Hill, N.C. 27516-7702


*Check/Payment MUST be received within 3-5 days (otherwise, a camper spot cannot be guaranteed)*

 

BY CLICKING "Agree", I HAVE READ THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.