Camp Registration

Address

City

Zip

Home

Mother

Simply the Best Training There is

Camper

# 1 *

At The Pleasant Dale Chalet -

8300 S Wolf Rd. Willow Springs, Il 60480

Tuesdays

January 5,12,19, 26

Feb 2,9,16,23 & Mar 2

U10 - 12 @ 5:00 / U 13 - 15 @ 6:00

C - Session ChaletAll LevelsU10- U12 Coed5:00 - 6:00pm$100.00 for 9 Sessions

D - Session ChaletIntermediate U13 - U15Coed6:00 - 7:00pm$100.00 for 9 Sessions

G - Individual Dates All Skill Levels U10-U12 CoedEither Location $15 per Session

H - You Choose Intermediate U13-U15 CoedEither Location $15 per Session

Camper # 2

Emergency Contact If Parent / Guardian cannot be reached

Emergency Contact Name *

Home Phone *

Cell

Medical Conditions Required Na if none *

Physician Name

Insurance Co.

Phone

Holders Name

Policy #

Group #

Click here to see Authorization Form

I acknowledge that I have read and accept the terms of the Authorization for Emergency Medical Treatment and Liability Waiver and I am a Parent and / or Legal Guardian for the Child or Children listed on this form

First Name * Last Name * Age * Current Team

Name

Home Phone *

Cell Phone

Email Address

Father

Physician Phone

STP Futsal Registration Form

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