Please fully complete the registration form below. Once we have received your form we will be in contact with you via email or mail to confirm and set up payment arrangements. Thank You!
*Name:
(First/Last)
*Street Address:
*City:
*State:
*Zip:

*Parent/Guardian:

*Home Phone:

*Cell Phone:

*Email:
 

*School:

*Age:

*Skill Level:

 Recreational Player
Club Player
High School Player
Upcoming High School Playerio

*Position:

 Field Player
Goal Keeper nal
 

Statement & Release :

 I waive and release Anthony Maher, Matthew Maher, Dwight Dunbracco, Maher Brothers Pro Touch Soccer Camps LLC and all Soccer Staff from all liabilities for any injuries and/or illness incurred while being trained. I hereby authorize the staff to act for me in the case of a medical emergency. I give permission for a physician or medical staff to administer needed treatment or care.

*E-Signiture:

 I waive and release
I do not waive and release nal
 
*Emergency Contact Name:
(First/Last)
*Emergency Contact Phone:
 
*Site Location:

*Camp Program:

Mini-Kickers $145 (4-6yrs)
Half-Day Camps $145 (6-15yrs)
Full-Day Camps $180 (6-15yrs)
High School Elite Training $150 (14-18yrs) io
*T-Shirt Size:

*Lunch Break:

 YES!! 2 pieces of pizza and a drink daily
$20 for the week/$4 a day
(I will pay at the beginning of the week)

No Thank You, I am not a Full Day Camper

Not sure yet or maybe some days
(I will pay per day in the morning if I choose.)
Comments:
i.e. Sibling discount, camp friends grouping requests, any concerns
 
* Required Fields