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WSA SOCCER SYNERGY CAMP REGISTRATION 2010
Please complete the online registration form and hit "submit" when you have competed the digital signature at the bottom. You will need to complete a different and unique online application for each child registering and for each camp.
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To confirm your application you will need to mail a check to: Soccer Synergy Camps, 5214 Greenan Drive, Sand Springs, OK 74063. Make checks payable to: Soccer Synergy CAMPS and please note the name of the camp and the camper's name on the check. Note that each camp has it's own unique entry fee. We look forward to seeing you at one of our camps this year!
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| Camper's Name |
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| Camper's Age and Date of Birth |
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| Select Camp Program From Dropdown Menu |
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| Gender |
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| Which Age Division Program Do You Play For |
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| Parent(s)/Guardian(s) Name |
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| Mailing Address Street |
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| Mailing Address City/State/Zip |
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| Email Address (receive camp weather updates, etc) |
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| Parents' Cell Numbers |
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| Parent's Home Phone |
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| Doctor's Name & Phone |
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| Health Insurance Company & Policy Number |
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| Tshirt Size (note: not all camps offer tshirts as part of camp program) |
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| List Any Medical Problems or Other Comments |
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I hereby authorize authorize the WSA Camp Staff and Soccer Synergy Staff to act for me according to their best judgement 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.
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I also understand the camp retains the right to use for publicity and advertising, photographs and videos of campers taken while attending the camp.
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I AGREE TO THE ABOVE STATEMENT AND VIRTUALLY SIGN THIS DOCUMENT BY TYPING MY NAME IN THE BOX BELOW:
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| PARENT'S DIGITAL SIGNATURE |
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| Choose your payment method: |
Mail a check to pre register and confirm spot in camp
Hand deliver a check on the first day of camp during on site registration
Credit Card Online (see instructions) |
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ATTENTION: To complete your application remember to mail a check to Soccer Synergy Camps, 5214 Greenan Drive, Sand Springs, OK 74063. Make checks payable to Soccer Synergy CAMPS. See camp information at www.wsasoccer.org for price of each camp.
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After hitting SUBMIT wait for form to load, review results, and click CONTINUE at top of page, and hit CONTINUE again when prompted to return to WSA Website.
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