Registration

Player Name (required)

Parent/Guardian Name (required)

Home Phone Number (required)

Cell Phone Number(required)

Address(required)

City, State, Zip(required)

Camper's Age (required)

Medical Information which should include allergies, medications, injuries, etc. If none, list none. (required)

Insurance Carrier(required)

Subscriber Name (required)

Policy Number(required)

Group Number(required)

In the case of any emergency, every attempt will be made to contact the above names parent/guardian from any and all numbers provided. The above named parent guardian by agreeing, authorizes the camp staff to provide or arrange for emergency or medical care if necessary. Any expense arising from injury or illness is solely the responsibility of the camper and the above named parent/guardian.(required)

Waiver Electronic Signature (required)

Nashua Location

$213.32 + $6.68 Processing fee = $220 If you don’t want to pay the processing fee, please email me and we can sort out payment via check. Additionally, if you have siblings attending camp, please email me for sibling discount. (lauraraysoccercamp@gmail.com)

$220.00

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