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Capital SC: Jay Peak Weekend, 2019
Please register your child here for our Golden Goal Weekend (April 26th - April 28th). Payment due date is Wednesday, February 28th.
Capital Soccer Club
Jay Peak 2019 (April 26, 27, & 28)
Name of player attending *
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Gender *
Year of Birth *
Which Capital Soccer Club team does your child play for? *
Full street address *
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City/Town *
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State *
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Zip Code *
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Emergency Contact #1 Name *
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Emergency Contact #1 Phone Number *
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Emergency Contact #1 Email Address *
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Emergency Contact #2 Name *
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Emergency Contact #2 Phone Number *
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Emergency Contact #2 Email Address *
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Allergies or Medical Conditions: Please include perscriptions *
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Physician Name *
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Physician Phone Number *
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Insurance Company Provider *
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Insurance Policy Holder *
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Insurance Policy Number *
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Capital SC is in need of adult volunteers to chaperone our trip to Jay Peak. Are you able to be a chaperone? Please considering helping us this weekend. If you can attend, and are willing to help chaperone your child's team, please list your name below. Note: There are no charges for chaperones to attend & assist.
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By registering my child for the Capital Soccer Club, Jay Peak Weekend, I acknowledge that the non-refundable fee of $230 is due by Wednesday, February 28th. Checks made payable to: "Capital Soccer Club Inc." Checks can be sent to: Capital Soccer Club Inc., 4 North Park Drive, Montpelier, VT. 05602. Please write the player name on the memo line of the check. *
I will complete all three of the required Golden Goal Forms (Participation, Health History, & Immunization) and will submit them to the staff at Golden Goal upon check in. *
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