OSC Summer 2003 Camp Registration

Please print and fill out this form. (Click here for information about OSC's summer camp program.)
Wite a check for the camp's cost to "Olney Soccer Club".
Mail the completed form and check to:
        Olney Soccer Club
        PO Box 552
        Olney, MD 20830

Please check the camps you wish to attend:

	Camp	Dates	Time	Cost
___	Day Camp Session I	July 14 - 18	9:00AM - 3:30PM	$170
___	Day Camp Session II	August 4 - 8	9:00AM - 3:30PM	$170
___	Advanced Evening Camp Session I	August 4 - 8	5:00PM - 8:00PM	$130

Name:

Email address:

Phone with area code - Day:

Eve:

Address:

City:

State:

Zip:

Age:

Birth date (m/d/y):

Medical concerns:

__ No __ Yes (explain):

Soccer club or program in which child participated Fall 2002/Spring 2003:

Emergency Contact:

Name:

Emergency contact phone numbers with area code

Day:

Evening:

Cell:

Release: As the parent/legal guardian of the above named child, I do hereby release and hold harmless Olney Soccer Club and its officers, directors, agents, and subcontractors from any and all liability associated with its operations of the camp and my child's participation therein.

Signature of parent/legal guardian:

Date:

Last updated .