SOCCER CAMP REGISTRATION FORM  

Name: _________________________________  (M / F) Age:______  Playing exp. _____(in years)

Name: _________________________________  (M / F) Age:______  Playing exp. _____(in years)

Name: _________________________________  (M / F) Age:______  Playing exp. _____(in years)

Address: _____________________________________________________

City:_______________________________   State: _____     Zip: __________ Phone: ____________

Email Address: _________________________ DOB: ___/___/___  Phone: (_____) _____ - _______

Parent/Guardian Name: _____________________________________________

Address (if different that child): __________________________________________________

_____________________________________________________________________________

Phone: (_____) _____ - _______        E-mail: _________________________________

Additional Emergency Contact Phone/Name: ____________________________________________

Please list any allergies or medical conditions: _______________________________________________________________________________

_________________________________________________________________________________________________________________

Check for $145/player payable to: Bogie Soccer Academy
MAIL TO: 112 Edwards Rd. Clifton,NJ 07013

For more information contact Ron Sevean at 973- 600 2055 or rpsevean@embarqmail.com or Bogie at 973-472 5175 www.bogiesocceracademy.com