Super Soccer College Prep Camp 2010

Camp Selection

Super Soccer College Prep Camp (June 20-24) - Residential Camper - $495.00 - We're sorry, this camp is now closed.

Super Soccer College Prep Camp (June 20-24) - Extended Day Camper - $370.00 - We're sorry, this camp is now closed.

Billing Information

Name as it appears on credit card

^{First Name}

^{Last Name}

Billing Address

^Address
^{Address Line 2}
^City	^{Billing State}
^{Zip Code}	^Country

Telephone Numbers

Home Number

Work Number

Cell Number

E-Mail Address

Credit Card Information

Type: Visa Master Card American Express Discover

^{Credit Card Number}
/ ^{Expiration (mm/yyyy)}	^{CVV Code}

Parent / Guardian Information

Check this box if the following information and your billing information are the same.

Name

^{First Name}

^{Last Name}

Billing Address

^Address
^{Address Line 2}
^City	^{Billing State}
^{Zip Code}	^Country

Telephone Numbers

Home Number

Work Number

Cell Number

E-Mail Address

Camper Information

Camper's Name

^{First Name}

^{Last Name}

Camper's Age

Camper's Birthday

/ /

Camper's Grade in Fall 2010

Position and Playing Level

Camper Shirt Size

Please list your roommate preference,if any. (Up to three).

Roommate 1

Roommate 2

Roommate 3

ADDITIONAL FORMS NOTICE

By clicking on the box to the left and entering my name and today’s date into the fields below, I hereby submit registration for Super Soccer College Prep Camp 2010 at Ohio Wesleyan University. I understand that I am responsible for downloading, printing, and completing the medical release form which is REQUIRED for my child to attend camp, and am aware that these forms are to be turned in at checking on the first day of camp.

^{Full Name}

^Date