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.
Name:  
Address:  
City:   State:     Zip:  
Parent's Name:  
Home Phone:  
Work Phone:
 
Cell Phone    
EMAIL Address (All Return Information will be sent to this email):  
Personal Information  
Date of Birth:     Age:  
Grade in school fall 2009:     Name of school:  
Residential / Team Camps Only  
Field Player Goalkeeper
Roommate Preference:    
Team Camp Only  
Team Name:     Coach's Name and Phone:  
Indicate Which Camps You Will Attend  
Day Camp I: June 8-11
$185
Boy's Jr. Residential / Goalkeeper: June 13-16
$360
Boy's Jr. Commuter / Goalkeeper: June 13-16
$305
Girl's Residential / Goalkeeper: June 20-24
$455
Girl's Commuter / Goalkeeper: June 20-24
$375
Girl's Team Camp Residential: June 25-28
$375
Girl's Team Camp Commuter: June 25-28
$315
Day Camp II: July 13-16
$185
Boy's Team Camp Residential: July 21-24
$375
Boy's Team Camp Commuter: July 21-24
$315
Boy's Residential / Goalkeeper: July 25-29
$455
Boy's Commuter / Goalkeeper: July 25-29
$375
A $125 deposit is required for all Residential & Team camps ($30 deposit for all Day camps) Return this form with required deposit (payable to Missouri State Soccer School)
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:    
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.