
| SPRING AND SUMMER 2009 APPLICATION |
| NATIONAL CAPITAL SOCCER ACADEMY |
| SOCCER CAMP |
| Name: | |
| Address: | |
| City: | |
| State: | |
| Zip: |
| E-mail address: | |
| Home Phone: |
| Boy Girl | Age: |
| Birthdate: | |
| Grade in Sept '09: | |
| School: | Club: |
| Soccer Experience (# of seasons): | |
| Positions Played: | |
| Height: | Weight |
| Father's Name: |
| Father's Work Telephone: |
| Mother's Name: |
| Mother's Work Telephone: |
| Tuition Fee | Please Check Session if you will attend: | |
| Session #1 June 8 – June 12, 2009 | $260.00 | |
| Session #2 June 22 – June 26, 2009 | $260.00 | |
| Session #3 August 3 – 7, 2009 | $260.00 | |
| Session #4 August 10 – 14, 2009 | $260.00 | |
| Session #5 August 17 – 21, 2009 | $260.00 | |
| Session #6 August 24 – 28, 2009 | $260.00 | |
| |
|
|
| Check T-Shirt Size: | Adult | S M L XL | Child | S M L |
|---|
| Early Drop-off (8:30 am) & Late Pick-up (5:00pm) |
$40.00 (for the week) |
|---|
| Deposit $75.00 ($25.00 non-refundable) | Yes | No | |
|---|---|---|---|
| Check No: | |||
| Check Amt: |
| I have printed and filled out a copy of the
Medical Waiver/Insurance Policy form |
Yes |