Camp Registration
Player's full name:	* required
Age:	* required
Grade:	* required
T-Shirt Size:	* required
Street Address:	* required
City:	* required
State:	* required
Zip:	* required
Parent's full name:	* required
Email:	* required
Home Phone:	* required
Cell Phone:	* required
Session:	Georgia Revolution Summer Training Series (May 22 - July 18) Summer Soccer Camp I (June 17 - 21) Summer Soccer Camp II (July 15 - 19) Goalkeeper Clinic I (June 17 - 21) Goalkeeper Clinic II (July 15 - 19)
Emergency Contact Name:	* required
Emergency Contact Phone:	* required
Existing Physicial Conditions:
Insurance Company:	* required
Policy #:	* required
	The parent or guardian understands that the camper will be engaging in physical activity during the program which contains an inherent riskof physical injury, and the parent or guardian assumes the risk and releases PEAK FORM SOCCER and ROCKDALE YOUTH SOCCER ASSOCIATION, it's directors and employees from any and all liability for personal injury arising out of the camper's participation in the camp program. I hereby grant permission for my child to attend the PEAK FORM SOCCER soccer camp and to be treated by a licensed physician or member of the athletic training staff in the event of any injury, illness or mishap. I Agree

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Peak Form Soccer * 1780 Old Salem Rd * Conyers * GA * 30013

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