Whitecaps Whitecaps

Summer Camp Registration

Your E-Mail Address: 

Re-Enter Your Email:

  

Sessions:
Please check each camp you are registering for. 








Full or Half Day:
(Whitecaps members deduct $40 from full day and $20 from half day)

Camper Information

Age: 

Camper's Last Name: 

Camper's First Name: 

Address: 

City: 

State:  

Zip: 

Phone:

Birth Date: 

  

Gender:

T-Shirt Size:

School Grade: 

 Name of School:

Insurance Carrier:

Policy Number: 

Parent Information

Father's Name: 

Mother's Name: 

Emergency Contact:

  (name & phone)

Other Information

Special Physical or Medical Needs: 

Physicians Name:

Physicians Phone:

Medical Release: I verify that my child is covered by medical insurance. He/She has been checked by a qualified physician and is physically able to participate in soccer activities. I understand that playing soccer has the risk of injury. I release All Star Soccer, Inc., The Cleveland Whitecaps, it's employees, officers, agents, and hosting facilities from damages and liability that may occur while my child is at tryouts, practices, games, tournaments and other club functions.