Player Information

2024 Summer Soccer Camps - Georgetown

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First Name:*

Middle Name:

Last Name:*

Date of Birth:*

Gender:*

Male

Female

Unspecified

Non-binary

Address:*

Address 2:

City:*

State / Province:*

Zip / Postal Code:*

Are there any medical conditions/health concerns (allergies) we should be aware of?:*

Yes

Parent/Guardian Information

Parent/Guardian First Name:*

Parent/Guardian Last Name:*

Parent/Guardian Cell Phone:*

Parent/Guardian Home Phone:

Parent/Guardian Email:*

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Parent/Guardian 2 Cell Phone:

Parent/Guardian 2 Home Phone:

Parent/Guardian 2 Email:

Emergency Contact

In an emergency, when parents/guardians cannot be reached, please contact:

Primary Emergency Contact First Name:*

Primary Emergency Contact Last Name:*

Primary Emergency Contact Relationship to Player:*

Primary Emergency Contact Cell Phone:*

Primary Emergency Contact Home Phone:

Have you been to one of our camps before?:

Yes

How did you hear about our camp?:*