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$25 per person
July 15-17
1 p.m.-2 p.m. | K-6th grades
Bring water, cleats, and shin guards
SOCCER CAMP 2020
505 ACADEMY ROAD | STARKVILLE, MS 39759 | PH: 662-323-7814 | FAX: 662-32305480
REGISTRATION FORM
STUDENT'S NAME
ADDRESS
STUDENT'S GENDER ENTERING GRADE
PARENTS' NAMES PARENTS' EMAIL
MOTHER'S CELL FATHER'S CELL
EMERGENCY CONTACT NAME & PHONE NUMBER METHOD OF PAYMENT (CASH OR CHECK) DATE OF PAYMENT
PARENTAL/GUARDIAN RELEASE:
I, (PARENT), CERTIFY THAT
(APPLICANT) IS IN GOOD HEALTH. I FURTHER CERTIFY, KNOWING THE CAMP WILL BE UNDER CLOSE SUPERVISION, THAT I WILL NOT HOLD STARKVILLE ACADEMY, ITS FACULTY OR THE DIRECTORS
OF THE CAMP RESPONSIBLE FOR INJURIES OR SICKNESS INCURRED BY MY CHILD DURING THIS CAMP.
SIGNED: DATE: