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Community Summer Soccer Camp July 10th-13th (8:00 a.m. -11:00 a.m. @ Chaos Soccer Complex (2297 Litsey Rd. Roanoke) Ages 5-15
Please fill out the form to sign up your child for the soccer camp. An email will be sent out with first day details one week before the camp start date. Please email me at
philipsalyer@gmail.com
with any questions
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Email
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Your email
Camper's First Name
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Camper's Last Name
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Camper's Date of Birth
mm/dd/yyyy
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Parent #1 First and Last Name
Your answer
Parent #1 Cell Phone Number
xxx-xxx-xxxx
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Parent #2 First and Last Name
Optional
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Parent # 2 Cell Phone Number
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Parent #2 E-mail Address
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Address
address, city, zip code
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Medical Information
If none type NA
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Payment Options
Camp Cost is $150 for the full camp and $75 for those 5 years old and under only participating until 1000 a.m.
Pay by Venmo to @Philip-Salyer ($150)
Email to arrange another form of payment ($150)
Pay by Venmo to @Philip-Salyer ($75/ 8:30 a.m. to 10:00 a.m.)
Email to arrange another form of payment ($75/ 8:30 a.m. to 10:00 a.m.)
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