Residential Camp Application

Complete this application in full. Send it with a $100 deposit or Full Payment
to UK International Soccer Camps, Inc. Make check payable to UK International.

Players Name:_____________________ Age:_____ Birth Date:__________

Parent/Guardian Name:____________________Player's Sex: M F (circle)

Address:_______________________________________________________

City:________________________ State:_________ Zip:________________

Phone: Home (___)____________ Work: Work (___)_____________

E-mail Address: _____________________________________

Name of Organization/Team: ______________________________________

Years of Playing Experience: _____

Date of Program Attending: _________

Location:_____________________________________

Check appropriate program:  __Individual   __Team   __Goalkeeper 
__Day __Extended Day __Overnight: Roommate request____________

__Premier Program (9-12 years)      __Level 1 __Level 2
 
__Champion Program (13-18 years) __Level 3 __Level 4
 
Shirt Size: __AS (34-36) __AM (38-40) __AL (42-44) __AXL (46-48)

Soccer Ball: __Size 4 __Size 5

Payment: $________     __Cash  __Check CK#________   Credit Card____

Credit Card (check one)   __Visa     __MasterCard    __Discover
#______________________
Credit Card Exp. Date (mo/yr): _______ Signature: ____________________

Discount $: ______________  Balance owed $: _______________________

 
How did you hear about us? _________________________________________

I certify that my child enrolled above is in excellent health and may participate in strenuous physical activities including soccer. I agree to defend and hold UK International Soccer Camps, its servants, agents and/or employees and contractors harmless from any and all claims for injuries sustained by my child during his or her participation in the camp. Permission is hereby granted to UK International Soccer Camps, to use pictures and any video footage of the campers in any promotional materials without compensation, plus all mailing and emailing addresses for any communication and/or programs. Permission is granted for my child to receive emergency medical treatment, and I certify that there are no limits to my child's participation except as stated in writing and included with this application.Refunds can be given at the discretion of UK International depending on the nature of the situation. Children who leave during the program due to injury or illness will receive a pro rata refund. A $25 handling fee will be required on any refund, no refund will be given for cancellation within 14 days of the camp start date. Children are enrolled on a fist come first served basis. We cannot guarantee enrollment any later than 7 days prior to camp. Should inclement weather or acts of God affect the program, any lost hours will be made up later in the week. If this is not possible, refunds will not be issued.

Signature:________________________________________ 

Date:_________________

Fax to:   (909) 793-7310  or mail to:

U.K. International Soccer Camps, Inc.
P.O. Box 1838
Redlands, CA  92373