| Note: You must first print this page in order to fill out and return application. To fill-out and return application click on the print button at the bottom of this page or go to File, then select Print. |
| ___ 6/25-6/29 Paramus Catholic High School | ___ 7/16-7/20 Pascack Valley High School |
| ___ 7/2-7/7 Paramus Catholic High School | ___ 7/16-7/20 Orangetown Soccer Complex, Orangeburg NY |
| ___ 7/9-7/13 Dorchester School, Woodcliff Lake | ___ 7/23-7/27 Orangetown Soccer Complex, Orangeburg NY |
| ___ 7/9-7/13 Orangetown Soccer Complex, Orangeburg NY | ___ 7/30-8/3 Orangetown Soccer Complex, Orangeburg NY |
| Parents/Guardian's Name _________________________ | Phone (_____) ______________________ |
| Child's Name ________________________________ | Email _______________________________ |
| Date of Birth _____________ | List team membership of camper, if any _____________ |
| ___Male/Female | ___ Check for Goalkeeper Training |
| Street ____________________________________ | |
| City ___________________________ | State _______ Zip _________ |
| If parent/guardian are not available in emergency contact: | |
| Name ________________________ | Phone ( ____ ) _____ - ___________ |
| Note: Make all checks payable to: World Class Soccer Camp |
| Mail to: World Class Soccer Camp, P.O. Box 175, HoHoKus, NJ 07423 |
| Credit Card: Credit card orders must be paid in full. Credit card orders may be faxed to (201) 261-3774. |
| BILL MY CREDIT CARD:___Discover ___MasterCard ___VISA |
| Signature ____________________________________ |
| Card # ____________________________________ |
| Exp Date ______/______ Security Code _____________ |
| Billing Address _____________________________________________ |
| City __________________________________ State_________ Zip___________ |
| Parent/Legal Guardian and applicant have read Camp policies as stated in "General Information" section. The applicant is in good health and has permission to participate in Camp activities except as noted in Medical Form. (Note: Camp will send you a Medical Form after receiving this application) |
| Parent or Legal Guardian_________________________ Date _______________ World Class Soccer Camp - P.O. Box 175 -, HoHoKus, NJ 07423 - (201) 261-3771 fax (201) 261-3774 |