FUTSOC USA - Winter Registration


	FUTSOC USA - Winter Registration

FUTSOC Winter Mini Camp
Registration Form

Participants Name:
E-Mail Address:
Sex:	Male Female
Age:
Birth Date:
Grade:
School:
Insurance:
Insurance Phone:
Physician:
Physician Phone:
Medical Condition	Yes No
If so, please list condition along with any applicable medication(s):
Weeks Participating (Check All that Apply):	Week#1 Dec 19th - 23rd Week#2 Dec 26th - 30th
Other. Please detail program required if different than options above. (i.e. - daily):