Chip Rohr's Soccer Camp Registration Form
Reminder: After you submit this form, you will then be responsible for downloading and completing the Emergency Data and Liability Waiver Form (located on the registration page of Chip Rohr's Soccer Camp website)
Email address *
Child's Full Name *
Your answer
Child's Nickname
Your answer
Birthdate *
MM
/
DD
/
YYYY
Sex *
Parent/Guardian Name *
Your answer
Address *
Your answer
Cell phone *
Your answer
Other phone
Your answer
Week(s) you are registering for *
Required
I'll need extended care
How did you find out about Chip Rohr's Soccer Camp?
Payment method *
A copy of your responses will be emailed to the address you provided.
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