Online Registration

Please complete and submit the following form:

Resident	Commuter	Half Day	Full Day
Name:
Address:
City:
State:		Zip:
Email:
Age:			Boy Girl
Soccer Position:
Team/Club:
Parent Name:
Parent Phone:		Work:
Cell:		Pager:
Emergency Contact:
Emergency Number:
Roommate Preference:
T-Shirt Size:	S M L	XL	Youth Adult

To complete this application, please remit the form containing the insurance waiver agreement and physician release with a non-refundable deposit of $75.00 by check. Balance is due at registration.