SOCCER CAMP 2020 - starkvilleacademy.org€¦ · soccer camp 2020 505 academy road | starkville, ms...
1
$25 per person July 15-17 1 p.m.-2 p.m. | K-6th grades Bring water, cleats, and shin guards SOCCER CAMP 2020 505 ACADEMY ROAD | STARKVILLE, MS 39759 | PH: 662-323-7814 | FAX: 662-32305480 REGISTRATION FORM STUDENT'S NAME ADDRESS STUDENT'S GENDER ENTERING GRADE PARENTS' NAMES PARENTS' EMAIL MOTHER'S CELL FATHER'S CELL EMERGENCY CONTACT NAME & PHONE NUMBER METHOD OF PAYMENT (CASH OR CHECK) DATE OF PAYMENT PARENTAL/GUARDIAN RELEASE: I, (PARENT), CERTIFY THAT (APPLICANT) IS IN GOOD HEALTH. I FURTHER CERTIFY, KNOWING THE CAMP WILL BE UNDER CLOSE SUPERVISION, THAT I WILL NOT HOLD STARKVILLE ACADEMY, ITS FACULTY OR THE DIRECTORS OF THE CAMP RESPONSIBLE FOR INJURIES OR SICKNESS INCURRED BY MY CHILD DURING THIS CAMP. SIGNED: DATE:
Transcript of SOCCER CAMP 2020 - starkvilleacademy.org€¦ · soccer camp 2020 505 academy road | starkville, ms...
$25 per person
July 15-17
1 p.m.-2 p.m. | K-6th grades
Bring water, cleats, and shin guards
SOCCER CAMP 2020
505 ACADEMY ROAD | STARKVILLE, MS 39759 | PH: 662-323-7814 | FAX: 662-32305480
REGISTRATION FORM
STUDENT'S NAME
ADDRESS
STUDENT'S GENDER ENTERING GRADE
PARENTS' NAMES PARENTS' EMAIL
MOTHER'S CELL FATHER'S CELL
EMERGENCY CONTACT NAME & PHONE NUMBER METHOD OF PAYMENT (CASH OR CHECK) DATE OF PAYMENT
PARENTAL/GUARDIAN RELEASE:
I, (PARENT), CERTIFY THAT
(APPLICANT) IS IN GOOD HEALTH. I FURTHER CERTIFY, KNOWING THE CAMP WILL BE UNDER CLOSE SUPERVISION, THAT I WILL NOT HOLD STARKVILLE ACADEMY, ITS FACULTY OR THE DIRECTORS
OF THE CAMP RESPONSIBLE FOR INJURIES OR SICKNESS INCURRED BY MY CHILD DURING THIS CAMP.
SIGNED: DATE:
