REGISTRATION FORM

 Please provide the following contact information:

Name		Age
Address
City
State		Zip/Postal Code
BirthDay
School
Club Team:
Telephone		E-mail
Father's Name
Work Phone
Mother's Name
Work Phone

Please identify and describe yourself:

Sex	Male Female
Height
Weight

First Session June 17 - 21

Second Session June 24 - 28

Third Session: July 01, 02, 03, & 05

Fourth Session: Not scheduled

Fee of $350.00 1st 2nd & 4th Sessions, $300.00 3rd Session Required.

Parent's Signature:___________________   Date:____________

In case of a medical emergency, if I cannot be contacted, I give permission for my child to receive emergency medical treatment. I wave and release The First Class Elite Soccer Camp, MCPS Staff and Officials from all liability to injuries and illness suffered while at camp.

Mail completed form to: First Class Soccer, c/o Friday Johnson, 9208 Hummingbird Terrace, #1741, Gaithersburg, Maryland 20879