McCarty Soccer Academy

PARENT / GUARDIAN INFORMATION
Parent / Guardian's name:
Address:
City:
State:
Zip:
Email address:
Contact Tel Number:
ATTENDEE INFORMATION
First Name:
Last Name:
School Attending:
Grade in School (Next Year):
Age:
T-Shirt Size:
Which camp session are you signing up for?
MEDICAL INFORMATION
Does the camper have, or has she/he had problems with any of the following? Allergies, Bee Stings, Asthma, Diabetes Heart Condition, Rheumatic Fever, Upset Stomach, Other	Yes No
Are ther any activity restrictions the staff should be aware of?	Yes No
Is the camper taking any medication?	Yes No
Additional Comments: