MSA Camp Registration

PARENT/GUARDIAN INFORMATION

Parent/Guardian's Name

Address

City

State

Zip

Your Email

Contact Phone #

ATTENDEE INFORMATION

Child's Name

Child's School

Child's Grade in School (Next Year)

Child's T-Shirt Size

SECOND ATTENDEE INFORMATION (Only fill out if signing up a second child.)

Child's Name

Child's School

Child's Grade in School (Next Year)

Child's T-Shirt Size

MEDICAL INFORMATION

Does the camper(s) 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

If yes, list child's name and condition(s).

Are ther any activity restrictions the staff should be aware of?
 Yes No

If yes, list child's name and restriction(s).

Is the camper taking any medication?
 Yes No

If yes, list child's name and list medication.

Additional Comments

CAMP INFO

FIRST CHILD

Which camp are you signing your child up for?
 MSA Junior Soccer Academy - $100 Futsal Mania - $100 Summer Rec Camp / Session #1 August 1-4 - $80 Summer Rec Camp / Session #2 August 8-11 - $80 MSA Skills Academy - $105

SECOND CHILD

Which camp are you signing your child up for?
 MSA Junior Soccer Academy - $100 Futsal Mania - $100 Summer Rec Camp / Session #1 August 1-4 - $60 Summer Rec Camp / Session #2 August 8-11 - $60 MSA Skills Academy - $105