Last Name:_________________________ First Name:_________________________
Parent(s) Name: _______________________________________________________
Address: ______________________________________________________________
City: _________________________________ State: _________ Zip: ______________
Phone: __________________________ Alt. Phone: ___________________________
Email: _____________________________________ Date of Birth: ________________
Unusual Medical Conditions: _______________________________________________
I will attend the following (circle one):
9:00 – 11:30 a.m. - 8 and under ($80)
1:30 – 4:30 p.m. - 9 to 13 years ($95)
T-Shirt Size: YS YM YL AS AM AL
Please print and mail this form with payment to:
Mr. Soccer Camps
4110 Circle View Dr
Williamsburg MI 49690
