Kelley Guth Sure Shot Soccer Academy

REGISTRATION INFORMATION

Participant Last Name Participant First Name Age: 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Gender: Male Female T-Shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large Mailing Address Email Contact 1  * required Home Phone Cell Phone Emergency Contact Person Emergency Contact Cell Phone Camp Selection Under 5 Mini Academy Under 6 Mini Academy Under 7 Junior Academy Under 8 Junior Academy Under 9 Junior Elite Academy Under 10 Junior Elite Academy Under 11 Senior Academy Under 12 Senior Academy Camp Price $75.00 Discount (Choose 1 Only) $10-Military $10-APSU Staff $10-APSU Faculty $10-APSU Alumni $10-APSU Student $10-Sibling Discount Known Allergies or Medical Conditions