Moxie Summer Camp Registration

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<i>Please note, registration is not complete until payment is received.</i>

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Player Info

Clinic Registration Option *

July 23rd - 27th: U14 and Under, 9AM - 12PM

July 23rd - 27th: U15 - U18, 1PM - 4PM

August 13th - 17th: U14 and Under, 9AM - 12PM

August 13th - 17th: U15 - U18, 1PM - 4PM

Player First Name *

Player Last Name *

Player Date of Birth *

07/04/1976

Street Address *

527 Eastlake Ave S

City *

Seattle

Zip Code *

98109

Home Phone Number *

206-555-1212

Player Cell Phone Number

206-555-1212

Player Email Address *

Player T-Shirt Size *

All t-shirts are unisex adult sized

X Small

Small

Medium

Large

X Large

Parent Info

Parent First Name

Parent Last Name

Parent Cell Phone Number

Parent Email Address *

Alternate Parent Email Address

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