Last Name:__________________________ First Name:__________________________
Parent(s) Name:__________________________________________________________
Address: ________________________________________________________________
City: __________________________________ State: _________ Zip: ____________
Phone: ____________________________ Alt. Phone: ___________________________
Email: ______________________________________ Date of Birth: _______________
Team*: _____________________________________ Position: ___________________
Medical Conditions: _______________________________________________________
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
* Players registering as a group of four or more receive a $20 discount. If applicable, please pay $145 instead of $165.
