ESA Camp Application

(kick "Submit" at the bottom of page when you have completed form)

Athletes NAME:

Gender:

   Male   Female
Date of Birth Age:
E-Mail Address
Home Phone
   
Mailing Address
City
State
Zip
   
Shirt Size Sm   M   L   XL
   
Summer Soccer Camp
   

June & August 2010

  
 
 
Please mail players 
Annual Physical 2010
 
 
 

wk One 7/12 Full Day $275.00
wk Two 8/9 1/2 Day $150.00

 (8:30am -4:00pm)

 
   
Register before 6/1/10 Register before 6/1/10
Full Day  1/2 Day

 $225.00

$125.00
   

Single Sessions are available at a rate of $60.00 / daily session

Select desired sessions: 

  Mon Tue Wed Thurs Fri
AM
PM
   

Discounts are available to teams of 10 or more players.

($15 OFF per/athlete)

(Discount only applies to athletes attending all 5 full day sessions)

Team Applications must be sent together.

 

 

 
A $100.00 non-refundable non-transferable reservation deposit must be sent before June 1, 2010 (you may send the full amount at once if you prefer).

Remaining balance must be paid in full by the first day of Camp. All check should be made payable to European Soccer Academy camp and mailed to:

European Soccer
Academy
PO Box 494
Worcester  MA 01613
 
MEDICAL RELEASE:  Please mail players 
Medical Conditions

Annual Physical
 

 
1. List allergies, medications,

 illnesses, injuries, etc)
2. In case of emergency notify:
   
3. Relationship to athlete:
   
4. Home Phone
   
5. Other Phone:
   
The above named camper has my permission to participate in the ESA camp program between July 8, 2010 and August 14, 2010. I further certify that him/her is capable of participating in a strenuous physical activity, to wit soccer. I also agree to hold harmless the ESA soccer camp, its staff, agents, the St. Peter Marion Junior Senior High School, and employees from any and all injuries which may be sustained by the camper during his/her participating in the clinic week. In case of emergency, I understand every attempt will be made to contact the person(s) listed above. If contact is unsuccessful, I give my permission to the tending physician to render medical treatment to the participant, including (if necessary) hospitalization. Any expense arising from or illness is the responsibility of the person signing below.  

 

  

Insurance Company
Policy Number
Electronic Signature