FUTSOC USA - Registration


	FUTSOC USA - Summer Registration

FUTSOC Summer Soccer Program
Registration Form

Participants Name:
Sex:	Male Female
Age:
Birth Date:
Grade:
School:
Experience Type:
Experience (Years):
Insurance:
Insurance Phone:
Physician:
Physician Phone:
Medical Conditions	Yes No
If so, please list condition along with any applicable medication(s):
Mother / Gaurdian:
Email:
Work Phone:
Cell Phone:
Home Phone:
Place of Employment:
Home Address:
Mother Permitted to pick up participant(s):	Yes No
Father / Gaurdian:
Email:
Work Phone:
Cell Phone:
Home Phone:
Place of Employment:
Home Address:
Father Permitted to pick up participant(s):	Yes No
Other individuals authorized to pick up camp participant(s):
Emergency Contact #1:
Phone Number:
Emergency Contact #2:
Phone Number:
Half day or Full day:
Specify Plan:
Weeks Participating (Check All that Apply):	Week#1 June 13th - 17th Week#2 June 20th - 24th Week#3 June 27th - July 1st Week#4 July 4th - 8th Week#5 July 11th - 15th Week#6 July 18th - 22nd Week#7 July 25th - 29th Week#8 August 1st - 5th Week#9 August 8th - 12th Week#10 August 15th - 19th
Other. Please detail program required if different than options above. (i.e. - daily):