Soccer Camp Registration 2018
Soccer Camp Registration 2018
Child's First Name  * 
Child's Last Name  * 
Birth Date (MO/DA/YEAR)  * 
Age  * 
T-Shirt Size:  * 
Soccer Experience  * 
Gender  * 
How did you hear about Soccer Camp?  * 
Parent Full Name(s)  * 
Name of Bridgeway friend (if one referred you)
Phone Number  * 
Street Address  * 
City/ST/ZIP  * 
Your Email Address  * 
Alternate Pickup: Full Name
Alternate Pick Up Phone
Is Bridgeway your home church?  * 
Name of your home church if it is not Bridgeway. Or, NONE if you have no home church.
Please detail any allergies or medical conditions we should know about.
List all medications child is currently taking.
Health Insurance Company Name  * 
Health Insurance Policy Number  * 
Family Physician's Name  * 
Family Physician's Phone Number  * 
Emergency Contact Name  * 
Emergency Contact Phone  * 
COST: Soccer Camp fee is $35 ($30 by June 15) which includes a t-shirt and soccer ball. You will be required to submit your payment online in order to register.
Please type in the box to the right »  * 
Total $
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