AYSO Soccer Community Day Camp Application

Complete one application per player. Make check(s) payable to AYSO Soccer Camps.
Mail with full payment to AYSO Soccer Camps, Inc. P.O. Box 1838, Redlands, CA  92373
or fax to: (909) 793-7310. Call office (888) 857-6222, or local coordinator for further information.

Players Name:_____________________ Age:_____ Date of Birth:_________________

Parent/Guardian Name:____________________ Player's Sex: M F (circle)


City:___________________________ State:____________ Zip:___________________

Phone: Home (___) _________________ Work (___) ___________________________

E-mail Address: _________________________________________________________

Name of Organization/Team: _______________________________________________

Dates of Camp: __________ Location: _____________________Camp Code:________

Half Day Full Day Time of Session:___________________________________
Check appropriate boxes:Fun in the Sun (4-6yrs.)Skills'n'Thrills (7-10yrs.)
Compete With your Feet (11yrs.+) Team (If available) GK (If available) Strikers (If available)
Camp Cost: $ ________ Family Discount ($5 for 2nd, 3rd, etc. sibling)
GK Clinic $30 (optional) Strikers Clinic $30 (optional) Ball $15 (optional) Water Bottle $5 (optional)
Shinguard $10 (optional) XXS (5-6 yrs) XS (7-8 yrs) S (9-12 yrs) M (13-16 yrs)
Total Cost $ _____ Payment: $________   Cash   Check CK#_____ Credit Card
Credit Card (check one)  Visa      MasterCard     Discover
#_________________________________________ Credit Card Exp. Date (mo/yr): _______

Credit Card Verification(3 digits) #:_______ Signature: __________________________

YES, I want more information on: Hosting a coach Residential programs
How did you hear about us? _________________________________________

I Certify that my child enrolled above is in excellent health and may participate in strenuous physical activities including soccer. I agree to defend and hold AYSO & UK International Soccer Camps, its servants, agents, and/or employees and contractors harmless from any and all claims for injuries sustained by my child during his or her participation in the camp. Permission is hereby granted to UK International Soccer Camps, to use pictures and any video footage of the campers in any promotional materials. Permission is granted for my child to receive emergency medical treatment, if needed, and I certify that there are no limits to my child's participation except as stated in writing and included with this application. Refunds can be given at the discretion of UK International depending on the nature of the situation. Children who leave during the program due to injury or illness will receive a pro rata refund.
A $25 handling fee will be required on any refund, no refund will be given for cancellation within 14 days of the camp start date. Children are enrolled on a first come first served basis. We cannot guarantee enrollment any later than 5 days prior to camp. Should inclement weather affect the program, any lost hours will be made up later in the camp week.
If this is not possible, refunds will not be issued.

Camp equipment cannot be guaranteed for players who register less than 10 days prior to camp.

Signature of Parent/Guardian...................................................................... Date.................................