BOYS AND GIRLS 2011 VIKING SOCCER CAMP REGISTRATION FORM
Please TYPE in responses, PRINT form, and remember to SIGN form.

LAST NAME FIRST NAME male female
ADDRESS CITY STATE ZIP
DATE OF BIRTH GRADE & SCHOOL FALL 2011
HOME PHONE EMERGENCY PHONE
EMAIL
NAME OF TEAM CURRENTLY PLAYING ON (only necessary if applying team discount)
CAMP SESSIONS
Session I August 8th-12th 9:00AM-12:30PM

T-SHIRT SIZE YM YL AS AM AL AXL

PAYMENT: Tuition for camp is $140.00
Early Enrollment Discount - Registration form mailed before May 1, 2011 Tuition $125
PLEASE VISIT OUR WEBSITE FOR SPECIAL ONLINE ONLY DISCOUNTS!

PARENT AGREEMENT
I certify that the named participant is in good health and physically able to participate in this camp. I understand the risk involved with such participation. My child is currently covered by medical insurance. I will in no way hold the Camp, the director, the staff, or the Viking Backers responsible for any injuries resulting to my child while participating in the Viking Soccer Camp.
Name of Participant
Signature of Parent/Legal Guardian DATE
Parent/Guardian's Printed Name
Make check payable to VIKING SOCCER CAMP and MAIL check and form to:

Viking Soccer Camp
c/o Mike Linsenmeyer
6730 Allview Drive
Columbia, MD 21046