Soccer Camp Signup Form
(Go slow! Fill in every line. A red star will show an error on line.)
(Don't mix phone numbers with letters on lines (i.e. 455-1234 Mike's cell- Improper entry)



Player Information

Name: (Last, First)  
Date of Birth:(mm/dd/yy)  
Gender:   Male   Female
School Name:  
Age:  
Parent/Guardian Name:  
Parent/Guardian Phone: (518-555-1212)  
Parent/Guardian Name:  
Parent/Guardian Phone: (518-555-1212)  
Shirt Size:  

 

Please indicate player’s special medical/physical condition(s).
If no such condition exists, write NONE.
NOTE: Put the medical condition in this field only, if you have other concerns send a separate email to patd@rysc.org.


Parent/Guardian Billing Information
Name:  
Address:  
 
City:  
State:  
Zip Code:  
Email Address :  
Phone
Number:
(518-555-1212)
 
     
Amt To Charge:
(After 06/15/14 -- $250.00 or $150.00)
 
   
Credit Card
Cardholder Name:  
Card Type:  
Card Number:  
Expiration Date:   /
     
Check
Your Check/MO* #

* Enter your check number in box. If you are paying with a MO (money order) and don't have one in your possession at this time, just type 999 in this space.
Please mail your payment within 1-2 days of registering.
Make your check or mo payable to: RYSC
Mail your payment to:
RYSC
3 Netherlands Blvd
Schenectady, NY 12306

Thank you!
 
     

I understand that soccer is a contact sport and that although efforts will be made
to provide safe and orderly practice and game conditions, there will always remain
possibility of serious injury. Recognizing that such risks exist, I give my permission
for my child to participate in this activity. I give permission to authorize medical
treatment for my child should the need arise. Also, I give my consent to any
photos taken of my child can be used on the RYSC website for the purpose of
advertising this program.

I agree to the statement above.

   

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