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Glen Cove Junior Soccer League
Summer Soccer Training Camp

Detach form below and return in envelope
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INDIVIDUAL PLAYER REGISTRATION
CAMP ATTENDING: Glen Cove Junior Soccer League.
     ___July 24-28    9AM-1PM          ___Aug 14-18    9AM-1PM   
At Glen Cove City Stadium on Morris Ave.
     

Player’s Name_______________________________________M_____F_____
Address__________________________________________________
Town______________________________________Zip___________
Phone: ________________________________Birthdate_________________

Club Currently Registered With___________________
FEES: (Cirle One) 1st Child - $125     2nd - $115     3rd - $105     4th - $95
AMOUNT PAID (MUST BE BY CHECK):____________
(Payable to the Glen Cove Junior Soccer League)
(Returned checks will be charged a $10 fee.
Late registration: $10 per child)
LEVEL OF CURRENT PARTICIPATION
(circle one)
INTRAMURAL         TRAVEL     ODP
Have you ever attended a LIJSL camp?
YES      NO
GOALKEEPER:
     YES      NO
SHIRT SIZE: (cirlce one)
YOUTH LARGE
ADULT SMALL
ADULT MEDIUM
ADULT LARGE
ADULT EXTRA LARGE
CHECK WEEK OF ATTENDANCE:
JULY 24-28    9am to 1 pm_____       August 14-18    9am to 1pm_____     
PARENTS
 Law requires that parental permission be on file so that medical attention may be given to minors.
The following consent form must be SIGNED and NOTARIZED so that medical assistance may be provided in an emergency situation.
I certify that to my knowlegde, the applicant is in good physical condition to take part in the LIJSL Camp Program
and I give my permission to have medical treatment as may be necessary for my child.

PARENT SIGNATURE_________________________________________DATE________________
FAMILY PHYSICIAN__________________________________________PHONE________________
INSURANCE CARRIER________________________________________POLICY #______________
EMERGENCY CONTACT_______________________________________PHONE________________



NOTARY___________________________________________________DATE________________

PICK-UP: Parents should arrive 5 minutes before the end of the session. No child will be dismissed with another camper unless Parent has given a written notice to the Camp Director.
RAIN: In the event of rain there will be a 1 hour delay policy, similar to tournaments. All decisions will be made at the site and by the Camp Director. Additional time will be added to subsequent camp days, when possible to make up for lost time. There are no per hour or per diem refunds.
REFUNDS: A maximum of 50% of camp fee may be refunded up to the day the camp begins. Returned checks will be charged an additional fee of $10.00


Campers will recieve a soccer ball and a camp T-shirt. Campers should bring a snack and a drink each day.


PLEASE MAIL APPLICATIONS TO CAMP COORDINATOR:
SUMMER CAMP
GLEN COVE JUNIOR SOCCER LEAGUE
PMB 126, 5 BREWSTER ST.,
GLEN COVE NY 11542