Please fill out and mail with check to:
Champions Soccer Camp
1937 Greenspring Drive
Timonium, MD 21093
Please make checks payable to: Lutherville Timonium Recreation Council
Player's name:_____________________________________________
M/F:___
Age and Grade in School:_____________________
What camp are you attending? (circle one)
July 7-11 Little Kickers July 7-11 Half Day July 7-11 Full Day
July 14-18 Little Kickers July 14-18 Full Day July 14-18 Half Day High School Prep (August 4-8)
Team Name and Age Group:__________________________________________
Are any of your teammates or friends attending Champions Soccer Camp? Yes___ No___
List players:________________________________________________________
(We want everyone to have a great experience at Champions Soccer Camp so we will try to keep friends in the same group!)
Uniform Size (circle one): YS YM YL AS AM AL
Emergency Contact Information:
Parent/Guardian Name:__________________________
Address:
_____________________________________________
_____________________________________________
_____________________________________________
Home Phone:_________________________
Work Phone:__________________________
Cell Phone:___________________________
E-mail:_______________________________________
(Please put a star next to the best way to contact you)
Liability Waiver
I hereby authorize Champions Soccer Training to act for me in their best judgment in any medical emergency.
I hereby waive and release Champions Soccer Training from liability for injury or illness incurred while at training.
I verify that __________________________________ (player's name) is physically able to participate in the activities of Champions Soccer Training.
________________________________________
(Signature of Parent of Guardian)
Mail-In registrations will be verified by an e-mail from Champions Soccer Training.