Community Summer Soccer Camp July 11th-14th (8:30 a.m. -11:30 a.m. @ Chaos Soccer Complex (2297 Litsey Rd. Roanoke) Ages 5-15
Please fill out the form to sign up your child for the soccer camp. An email will be sent out with first day details one week before the camp start date.  Please email me at philipsalyer@gmail.com with any questions
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Email *
Camper's First Name
Camper's Last Name
Camper's Date of Birth
mm/dd/yyyy
Parent #1 First and Last Name
Parent #1 Cell Phone Number
xxx-xxx-xxxx
Parent #2 First and Last Name
Optional
Parent # 2 Cell Phone Number
Parent #2 E-mail Address
Address
address, city, zip code
Medical Information
If none type NA
Payment Options
Camp Cost is $130 for the full camp and $65 for those 5 years old and under only participating until  1000 a.m.
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