For Your Security please fill out, print out, and send to:
Champship Soccer Camp LLC
69 Riverside Dr, Hamden, Ct 06518

Please enroll (Campers Name): Gender Please select one Male Female
Choose a Camp: Please click and select One July 6 - 11 Resident/Commuter Camp (12-17yrs) Daniel Webster College, Nashua NH August 4 - 8 Full Day Camp (6-12yrs) - 9:00am - 3:30pm Hamden High Sports COmplex, Hamden Ct August 4 - 8 Mini Day Camp (6-12yrs) - 9:00am - 11:30pm Hamden High Sports Complex, Hamden Ct July - August High School Boys and Girls Preseason Team Training Located at your team's training facility


Address Information:

Parents Name: Parents Email:
Home Address:
City: State: Zip: Home Phone:
Age as of camp Date: Date of Birth mm/dd/yr: Postion: Please select one Field Goalkeeper Field/Goalkeeper
Camp Roommate (2 in a room):
Where did you hear about the camp?


Parents Permission (required):

My son/daughterhas my permission to participate in all camp activities.
Parents signature


Emergency Treatment (required):

In case of an injury, I give my permission for a qualified nurse or doctor to give immediate care to:
Campers name:
Parents signature:
Emergancy Telephone number:
Family insurance Company and Policy#:

NOTE: Medical information must be submitted before child begins camp. Medical form will be sent upon receiving application.