2017 Missouri State Soccer School Registration Form

Please print this form, fill in the information, and mail it to the address at the bottom of this page.
City:   State:     Zip:  
EMAIL Address (Return Information will be sent to this email) Print Clearly!:  
Parent's Name:  
Home Phone: (               )                  
Work Phone:
(               )
Cell Phone: (               )  
Personal Information  
Date of Birth:     Age: ________  
Grade in school fall 2017:     Name of school:  
Individual / Team Camps Only  
Resident Commuter
Field Player Goalkeeper
Roommate Preference:    
Team Camp Only  
Team Name:     Coach's Name:  
Indicate Which Camp You Will Attend RESIDENT COMMUTER
Day Camp I June 5-8 NA $230
Day Camp II June 19-22 NA $230
Boys Jr. Individual Camp June 24-27 $405 $345
Girls Camp June 29 - July 2 $480 $420
Girls Team Camp June 29 - July 2 $400 $340
Boys Team Camp July 9-12 $400 $340
Boys Camp July 17-20 $480 $420
Select your T-shirt size  
Youth: M L Adult: S M L XL
Select size of soccer ball  
Size 4 (ages 7-11) Size 5 (ages 12 and up)
Total Enclosed:    
A $75 deposit is required for all Individual & Team Camps ($50 deposit for Day Camp). Return this form with required deposit (payable to Missouri State Soccer School).
Select method of payment
Check #     Cash
Discover   Visa   Mastercard
Credit/Debit Card #     Expiration Date: _____/_____/_____
Cardholder Name: (print)    
Cardholder Signature   Date:  

Mail To:
  Missouri State Soccer School
  P.O. Box 7055
  Springfield, MO 65801-7055

Missouri State Soccer School is owned and operated by Southwest Missouri Sports Camps, Inc.