Don't miss out on the hardest working program on Long Island...  "Train to Play, Play to Win"

Registration Form


Please Fill out and bring to registration table at first day of camp or clinic event.  Thank You!

 

Date:

 

 PLAYER INFO: 

REGISTRATION FORM:

NAME OF PLAYER:_______________________________________________________________
ADDRESS:__________________________________CITY:_______________ZIP:____________
DATE OF BIRTH:____/_____/____AGE:_____ GENDER: Female____ Male____ Grade______
HOME PHONE:______________________________ MOBILE PHONE:____________________
E-MAIL ADDRESS: _______________________________________________________________
EMERGENCY CONTACT:_______________________________PHONE:__________________
PROGRAM FEE PAID:$___________________________ CHECK #______________________
__

Parent/Guardian:
I certify that my child enrolled above is in good health and has my permission to participate in camp activities including soccer. I am aware of the risks associated with my son's/daughter's involvement in the camp and camp related activities. In the event of an emergency, I hereby give permission to ELS staff, camp director and physician selected by camp director to secure proper treatment for the camper. I will be fully responsible for all medical expenses incurred by my child while attending the prgram. I give permission to ELS to use my child's images in future advertising and Promotional materials.

Signature: _________________________________________________ (Parent/Guardian) Date: ____________________________

For any questions contact Jaime/Gary at elitelevelsoccer@yahoo.com or 516-369-7797

** Goalkeeper training is offered at every training site in conjunction with field players**
 


First Name: ________________________________

Parent Name: _______________________________

Address: _______________________________________________________________________

Telephone Number: ___________________________

Cell: ______________________________

Emergency Contact: __________________________

E-mail: _____________________________

Date of birth: ___/___/_______

Please Circle: M/ F

 Team: ____________________________

For T-shirt Orders:

Shirt Size: Youth: S M L Adult: S M L

 

Signature: ____________________________