Soccer Camp Registration Form
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2009 OC Soccer Camp December 19 - 21 CAMP REGISTRATION (Please use a separate registration form for each camper) CAMPER’S FULL NAME ____________________________________________ DATE OF REGISTRATION_______________ RESIDENCE ADDRESS_______________________________CITY_________________STATE_________ZIP____________ DATE F BIRTH______________________20________AGE AT LAST BIRTH_____________MALE_______FEMALE_______ SCHOOL______________________________________________ GRADE _______________________________________ SHIRT SIZE YS YM YL
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TELEPHONE NUMBER AT HOME _______________________________ E-MAIL ADDRESS__________________________________________ PARENT (1) EMERGENCY CONTACT INFORMATION: OFFICE_________________________CELL PHONE__________________________ FULL NAME________________________________________________ RESIDENCE ADDRESS_______________________________CITY_________________STATE_________ZIP____________ PARENT (2) EMERGENCY CONTACT INFORMATION: OFFICE_________________________CELL PHONE__________________________ FULL NAME________________________________________________ RESIDENCE ADDRESS_______________________________CITY_________________STATE_________ZIP____________
Where did you here about us? _________________________________________________________________________
Make checks payable to “OC Soccer Camp” Mail to: Mike Chilcott 665 South Rockridge Anaheim Hills, CA 92807 If you have any questions, feel free to contact: Mike Chilcott 310-925-8838 [email protected] or Gary Kleiban [email protected]
SML
TELEPHONE NUMBER AT HOME _______________________________ E-MAIL ADDRESS__________________________________________ PARENT (1) EMERGENCY CONTACT INFORMATION: OFFICE_________________________CELL PHONE__________________________ FULL NAME________________________________________________ RESIDENCE ADDRESS_______________________________CITY_________________STATE_________ZIP____________ PARENT (2) EMERGENCY CONTACT INFORMATION: OFFICE_________________________CELL PHONE__________________________ FULL NAME________________________________________________ RESIDENCE ADDRESS_______________________________CITY_________________STATE_________ZIP____________
Where did you here about us? _________________________________________________________________________
Make checks payable to “OC Soccer Camp” Mail to: Mike Chilcott 665 South Rockridge Anaheim Hills, CA 92807 If you have any questions, feel free to contact: Mike Chilcott 310-925-8838 [email protected] or Gary Kleiban [email protected]
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