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Camper's Name First Last
Camper's Age & Date of Birth
Select Camp Program From Dropdown Menu

Please select one camp program. If you wish to register for multiple camp programs or register multiple children, please complete a different registration form for each program and each child. THANKS!
Parent(s) Guardian (s) Name
Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email

Receive camp updates, weather updates, etc...
Emergency Contact Phone Number ### - ### - ####
HEALTH INFO: Doctor's Name; Insurance Company & Policy Number; Any Medical Problems or Comments

Please help us by providing as much information as possible.
TSHIRT SIZE
Digital Signature, I HAVE READ & AGREED TO THE STATEMENT (at the right margin) AND VIRTUALLY SIGN THIS DOCUMENT BY TYPING MY NAME IN THE BOX BELOW

I hereby authorize the WSA Camp Staff & Soccer Synergy Camp Staff to act for me according to their best judgment in any emergency requiring medical attention, and I hereby waive and release the camp and the camp staff from any and all liability for any injury or illness incurred while attending a Soccer Synergy WSA Camp Program. I have no knowledge of any physical impairment that would be affected by my child's participation in the camp program, as outlined in the camp information. I also understand the camp retains the right to use for publicity and advertising, photos and videos of campers taken while attending the camp.
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