McLoughlin School of Soccer
Summer Camp Registration Form
Player #1 Name:
Age: DOB:
Camp Location: Week Code(s):
Camp
Options:		 ___ Soccer Kids      ___  Half Day      ___ Full Day      ___ Speed Camp
___ Speed & Advanced Skills  ___  Speed & Advanced Skills with Full Day
Player #2 Name:
Age: DOB:
Camp Location: Week Code(s):
Camp
Options:		 ___ Soccer Kids      ___  Half Day      ___ Full Day      ___ Speed Camp
___ Speed & Advanced Skills  ___  Speed & Advanced Skills with Full Day
Home
Address:
Parent/Guardian Name:
Telephone #:
Email:
Additional Emergency Contact & Tel#:
I certify the above named applicant(s) emotionally ready, in good health and is given my permission to participate in this program.  I understand that there is some risk in playing soccer and soccer related activities and I am willing to assume those risks.  I certify that my child has no ailments or disabilities that would prevent my child from participating in McLoughlin School of Soccer activities.  I hereby agree to hold McLoughlin School of Soccer Inc., its agents, employees and contractors harmless from any and all claims for any injury or illness incurred by my child during participation in this program.  In case of emergency, I grant my permission to have my child given emergency treatment at a local hospital.  I also grant permission for any photographs taken of my child in the program to be used for future promotional use.

Parent Signature ______________________________________________________________  Date ______________

Camp Fees:

 Total Camp Fees
$ _____________

I would like to order the following merchandise to be delivered to me the first day of camp:

Quantity

 Item, Price, Sizes Available

Sizes Needed
_____ Shin Guards ($10) XXS, XS, S _____________
_____ Cleats ($20) red, unisex, youth sizes 9 - 13 1/2 _____________
_____ Starter Kit ($25) Ball, shin guards & bag

----------------------
_____ Soccer Kids Uniform ($30)  
Shirt, shorts & socks
Tshirt: S, M, L      Shorts: S, M, L

Tshirt  ___________

Shorts___________
_____ Soccer Kids Book ($12)  by Tom McLoughlin

----------------------
Total Merchandise Fees
$ _____________
Enclosed is my check for: Total  All Fees
$ _____________

 

How To Register:
1.  Print this page
2. Select which camps, week(s) and location(s) the applicant will attend. 
3.  REFUND POLICY: Please sign up only if your child is ready to participate in the class. Refunds are given only if we cancel a class. No refunds are given for registrants proven to be too young. A credit will be issued for withdrawals made no later than 48 hours before classes begin .
3.  Mail completed application form with check (made out to McLoughlin Soccer) to:

McLoughlin Soccer - Summer Camp
17 Division Street 
Somerville NJ  08876
4. No written confirmation will be sent.  If you request confirmation, please enclose a self-addressed envelope.
5. If a camp is closed out, you will be informed immediately upon receipt of application.

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