soccer camp 2020 - starkvilleacademy.org€¦ · soccer camp 2020 505 academy road | starkville, ms...
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![Page 1: SOCCER CAMP 2020 - starkvilleacademy.org€¦ · soccer camp 2020 505 academy road | starkville, ms 39759 | ph: 662-323-7814 | fax: 662-32305480 registration form student's name address](https://reader034.vdocuments.site/reader034/viewer/2022042521/5f5f1e8346b1062e387f8d7c/html5/thumbnails/1.jpg)
$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: