Name: ___________________________________________________________________

Age (during camp): ___________________________________________________________

Home Address _____________________________________________________________

City ______________________________ State___________ ZIP ___________________

Home Phone ______________________________________________________________

Email ________________________________________________________________________

School Attending __________________________________________________________

Grade Next Year____________________________________________________________

Name and phone number of family physician: ____________________________________

_________________________________________________________________________

I will attend:

Pee Wee Camp @ RU

June 16- June 20

Day Camp @ RU ($25 deposit)

June 23- June 27

Elite and Team Camp @ RU ($100 deposit)

July 20- July 24

For Elite and Team Camp, I will be a:

Commuter

Residential Camper

Team Name (if coming with a team) ________________________________________

T-shirt size (circle one)

Youth: S , M , L

Adult: S , M , L , XL

(T-shirts can not be exchanged for different size

I would like to purchase a camp ball for $25 (separate check made payable to Spencer Smith)

size 4

size 5

I have___ have not___ earned an athletic letter since entering the ninth grade (check one).

Roomate preference (not guaranteed): __________________________________________

ALL DEPOSITS ARE NON-REFUNDABLE

Checks payable to: Spencer Smith Soccer Camp or SSSC

OFFICE USE ONLY

PWC Deposit Paid _____________

DC Addt'l Payment ____________

AD & T Balance Due ____________